A look into physician life in Bismarck.
A look into physician life in Bismarck.

CV prep

Community profile: Bismarck, North Dakota

Table of Contents

The State Library and Capitol Tower are commanding features of North Dakota’s Capitol Complex located in Bismarck.
The State Library and Capitol Tower are commanding features of North Dakota’s Capitol Complex located in Bismarck.

City names have a way of changing before they settle down. Sometimes that’s because people realize monikers like Pigville could make them laughingstocks, or because names like Bombay fall victim to political correctness. In the case of North Dakota’s capital, though, name change had a calculated purpose.

The city debuted as Edwinton in 1872, honoring a Northern Pacific railroad engineer named Edwin M. Johnson. But then city leaders got a brighter idea: “Let’s use a name that will attract investment in ongoing railroad construction and newcomers with strong work ethics.” In other words, German money and German immigrants. The winning name: Bismarck, for German Chancellor Otto von Bismarck, the leader who had turned a patchwork of states into one country.

So, on July 17, 1873, the city was newly baptized. It was officially incorporated in 1875. After some lively “negotiations,” aka hog trading, in 1883, the town on the Missouri River became the capital of Dakota Territory. Six years later, Bismarck became the capital of the newly minted state of North Dakota.

The ploy to attract German capital worked, to a degree. But today’s population breakdown may tell the bigger part of the story. According to a recent census, Bismarck residents of German heritage comprise almost 58 percent of the population, followed by a distant 18.2 percent Norwegian and, in varying proportions of less than 10 percent, Russian, Irish, English, and Swedish. Free homestead land was too good for the early Germans to pass up, even if the Northern Plains terrain was flat and lacking in trees, and winters might be nasty. No problem. They were hardy and eager, the land was on the same latitude as home, and they were determined to make a go of it. And so they did.

Joined by smatterings of other ethnic groups over the years, they and their descendants toughed it out through long droughts, grasshopper invasions, and maybe worst of all—the Great Depression. Gradually, the settlers turned the near-treeless Northern Plains terrain into a welcoming green domain. Today, a grassy mall surrounds the capitol in Bismarck, and some 3,000 acres of parks, 45 hiking/biking trails and seven golf courses add to the welcoming ambiance.

Bismarck’s attractive downtown

Beautification projects are underway in the historic downtown, although, according to city planning director Carl Hokenstad, “We don’t have so far to go as some other cities, because we’ve never experienced the deterioration (that plagued) some of them.” One reason: “Our main regional shopping center is adjacent to downtown, which I think has been helpful over the years.”

Today, the pioneer legacy during tough times across the United States includes a $1.2 billion state budget surplus, no more than 3.5 percent unemployment, and bankers who refused to be influenced by either the U.S. government or Wall Street. In short, says Chamber of Commerce president Kelvin Hullet, “North Dakota is an interesting place because we have seemed resistant to what is happening in the rest of the economy. Real estate is stable, and prices are actually going up. State services are in good shape. And there’s been tremendous growth in energy (development).”

A spectacular vista of Painted Canyon, a part of Teddy Roosevelt National Park, located west of Bismarck, about two hours by car.
A spectacular vista of Painted Canyon, a part of Teddy Roosevelt National Park, located west of Bismarck, about two hours by car.

Financially solvent North Dakota

Brandon Price, DO, has a quick answer for anyone who asks, “Is North Dakota prosperous?” He blurts, “Oh, yeah!” Then he elaborates, “I just went to a Chamber of Commerce meeting with a lot of (local business leaders) who were at a (recent) national meeting. When other city representatives heard where they were from, they were actually pretty envious. Jobs here are abundant—and good paying jobs, at that. Our banks didn’t get into trouble, and people are still building homes.” For example, “There are still 120 homes to be built right near my house. I don’t think foreclosures have been an issue so far.”

A historical reenactor at Fort Lincoln State Park in Mandan, just across the Missouri river from Bismarck.
A historical reenactor at Fort Lincoln State Park in Mandan, just across the Missouri river from Bismarck.

Eric Hardmeyer, president of the Bank of North Dakota, America’s only state-owned bank, adds a professional view, with a down-to-earth touch. “Things right now are still pretty doggone good. By and large, I would agree that we’ve escaped the brunt of recession.” Continuing, “I’ll hedge that statement by saying that, as this (national downturn) goes on, we don’t know what will happen.” As a “banker’s bank,” with a mission to “encourage economic growth,” BND does not initiate home loans, but does buy them from other banks. Its other areas of concentration are development and agriculture. It also provides 60 percent of the student loans in the state, about which he adds, “We’re among the top five in lowest defaults. People just pay their bills here.”

Hardmeyer’s quick explanation for his and other banks’ avoidance of disaster: “Bankers here are generally a pretty conservative people. If we don’t understand it, we don’t do it. Our loans are underwritten properly, and we know our customers. We know their ability to pay, and we don’t overextend loans to them.”

“Somehow they learned from the last boom,” when inflated land values enticed farmers to overextend themselves, summarizes Carole Watrel, a New York State native who has lived in North Dakota since 1977 and in Bismarck since 1994.

As economics expert Russ Staiger puts it, “Much of our business is done on a handshake, and people move ahead. We still have that kind of honest belief in our fellow man.” Staiger is the president/CEO of the Bismarck- Mandan Development Association. (Mandan is Bismarck’s “sister city” on the west side of the Missouri River.)

Weather’s not as bad as people think

Over the years, the state has continued to be characterized as a kind of remote tundra in the middle of nowhere. Price, who grew up in Minot, one of the state’s large cities (population 37,000), begs to differ. First of all, he says, “Winters are cold, but not that bad,” even though he does admit to exceptions. “This winter, for instance, there was more snowfall in January than in the ten years previous. But I tell people we don’t raise wimps in North Dakota. If you want sun 365 days a year, you’re not going to get that here. At the same time, you don’t miss out on the beautiful season changes.”

And Staiger informs newcomers the last bad winter was the 1996-97 siege. As a lifelong North Dakotan, too, he revels in occasional astronomical displays like the Aurora Borealis (northern lights), and he still talks about a night when he witnessed “a fantastic thunderstorm in the east, with stars shining in the sky over Bismarck.” Daytime drivers along I-94 can sometimes marvel as multiple lightning bolts crackle across a deep gray sky.

Bismark, North Dakota Statistics
Bismark, North Dakota Statistics

Rural to urban migration

Yes, farm-town population is drying up in many cases, Price admits, but that’s because “people have been moving toward the Bismarck, Minot, Grand Forks, and Fargo areas for convenence. Some people want to be closer to (city medical care). I think some find it easier just to hop into their cars and go to the doctor’s office than having to make an entire day’s trip,” he speculates. A pet peeve is “North Dakota frequently gets labeled as flyover land. In actuality, there are a lot of good things here. It’s beautiful country. We do have running water. We actually drive vehicles. People also carry iPods and have Blackberries.”

Competitive manufacturing in Bismarck

Businesses have also heard about concepts like “Just in Time,” or JIT (a business strategy aimed at reducing inventory and maximizing efficiency). Case in point: the Bobcat Company, the city’s largest manufacturing employer, was founded in 1960 by brothers from two local families, produces small construction equipment. As an example, Staiger notes, “They can take a coil of 40,000 pounds of steel in the front door, and four hours later they can take a completed product out the back door. Toyota does the same in two-and-a-half hours, so that’s the Bobcat goal.”

In the meantime, a diligent workforce has attracted huge billing centers for telephone and electric corporations, as well as big box stores. “Home Depot, Lowe’s, Menard’s, women’s and men’s stores popped up overnight,” he recalls, “creating more than 2,000 jobs and attracting shoppers from as far away as South Dakota, Montana, and Canada.”

As for the general economy, it doesn’t hurt, either, says Hardmeyer, that “we’re coming off of two of the most prosperous years we’ve had in decades.” Astronomical wheat prices, among others, helped farmers “make huge advances,” and “we’re coming off of big years for energy,” one of the state’s perennial top moneymakers, which isn’t poised to fade any time soon. “North Dakota has a very diversified energy plan,” he explains.

It could also be called something for everyone: “The number one state in wind potential with tons of new wind farms, ethanol plants, endless acres of soybeans for biodiesel, energy and power plants, huge amounts of coal (now processed into natural gas), and huge oil reserves.” Estimates of oil deposits run from a low of three billion gallons to 100 billion, once a daunting cache to release, but now within reach thanks to modern technology including horizontal drilling practices enabling more and better access to oil.

Eric Thompson, MD, a family practitioner with Medcenter One, one of Bismarck’s two large hospitals, has his own take on North Dakota economics: “Land is a lot more affordable. I bought 60 acres I could not have afforded elsewhere. The price of my 60 acres here would be the price of one acre in Salt Lake City.”  Thompson puts his domain to good use. He, his wife, and three children have three horses, a donkey, three dogs, a rabbit, and four cats. He adds, not surprisingly, “I like to go riding. There’s a lot of nice open country to do that.”

View of government buildings from the Capitol Mall, site of the record-setting 2007 Snow Angel Contest (See Page 5)
View of government buildings from the Capitol Mall, site of the record-setting 2007 Snow Angel Contest

Modernized in 2005, the Bismarck Municipal Airport has two runways and is a stop for a number of large carriers including United and Northwest.
Modernized in 2005, the Municipal Airport is a stop for a number of large carriers.

Beautiful Hawktree Golf Course is one of seven courses in Bismarck.
Beautiful Hawktree Golf Course is one of seven courses in Bismarck.

Friendly lifestyle

Better yet, “People don’t care much about your getting on their land. You just kind of meet people, and they’re not in so much of a hurry, so they sit and talk toyou.” Even though Thompson, like Price, is a native North Dakotan, he has lived in California and Salt Lake City, so he adds, “That’s something I had to get used to. When you’ve been in the (big) cities so long, you think, ‘What do they want from me?’ But here they just want to get to know you, have you over and get friendly. It’s nice that they don’t have any secondary gain issues.”

Watrel, a former New Yorker adds, “We just like the lifestyle here; life is easy, and it’s fun living in the capital of a small state (in terms of population). You can do extra things without having to be a millionaire.” For instance, she is a member of the Bismarck Symphony board and has served as chairman of the city’s Committee on Aging.

Surprisingly for Thompson, his wife, whom he met during a “beach bum” hiatus in California, likes the lifestyle, too. “She’s from the Monterey area, (but) she  thinks the flowing grass and the prairie are beautiful.” He adds, “There are some beautiful places here,” such as the Badlands, the Rockies, and the Black Hills of South Dakota. “We’re not too far from them.”

As a native North Dakotan, he has fond memories of his boyhood “on a farm about 15 miles from the nearest town, which had 600 people, three bars and three churches. It was a good place to grow up because there wasn’t a lot of traffic or drugs or problems with the school system.” In a pleasing turn of events, his wife agreed to join him while he studied at the University of North Dakota School of Medicine. Then, after a stint in Salt Lake City, “It was actually my wife who suggested that we move back here, where my family lives. She said, ‘If we’re moving again, we’re moving to where we
have babysitters and grandparents.’ ”

Thompson has been pleasantly surprised by the current school system. “Having lived in California, Utah and Arizona, I think these are the best schools we’ve (encountered). All three children, 17, 9 and 6, attend public schools, a benefit for dad, too. “They do well enough there that they don’t need extra attention,” he quips, “and it keeps my wallet happier.”

Price, a family practitioner who is affiliated with St. Alexius Medical Center, the state’s oldest hospital, echoes the thought. As a native son, he’s had enough experience to justify his opinions. He left home for medical training at Des Moines University College of Osteopathic Medicine, followed by a residency in Minnesota. While there, he says, “I always heard (the term) ‘Minnesota Nice.’ The folks in North Dakota are just that, if not nicer. It’s almost like everyone is an extension of my family.”

Bismarck’s distinguished medical history

As North Dakota’s oldest hospital, St. Alexius bills itself as being part of “a unique tradition of healing and hospitality,” dating back to hospitals in ninth century Europe started by followers of St. Benedict. The “American extension” followed suit in 1885 when a Minnesota abbot (head of a monastery), Alexius Edelbrock, bought the year-old Lamborn Hotel in Bismarck and sent five Benedictine sisters to establish a facility there with 15 beds, a coal stove in each room, and a dollar patient charge per day. According to local lore, Theodore Roosevelt and the son of  Sioux Chief Sitting Bull were treated there.

Arriving in 1892, a savvy businesswoman, Sister M. Boniface, is credited with bringing St. Alexius into the “modern world.” When she died 45 years later, her legacy, as two local historians put it, was “a first-class 175-bed hospital.” Today, at least that number of physicians treat patients in a 749,000-square foot modern facility. Today’s ambiance includes friendly, welcoming pre- and post-surgical care units, and such state-of- the-art techniques as “revolutionary” as axial lumbar interbody fusion, easier lap banding, and a gas bubble treatment for diabetic retinopathy. All of the above are companions in a wholesale embrace of innovative technology, totally digitizing records and radiography procedures.

St. Alexius has received a Distinguished Hospital Award from HealthGrades, and has also been cited for excellence in patient safety. A long-time pledge: “Let all be received as Christ,” remains as its official slogan, but it’s hard to ignore a lighthearted “substitute”: “Until your original parts come with a guarantee, there’s St. Alexius.”

If citizens of the “Old West” genre were still active, it would be possible for one to shoot through a window of Medcenter One and hit St. Alexius. The two hospitals, of similar size, and equally committed to state-of-the-art care, sit a mere two blocks from each other in the center of the city. Medcenter One was “fathered” by Niles O. Ramstad, MD, when he asked the Evangelical Church to consider building a facility in 1907. He and business partner Eric P. Quain, MD, had formed a Mayo-inspired clinic in 1902. Bismarck Evangelical Hospital opened its doors in 1908. It became Medcenter One in 1984. Today, with some 140 physicians in four cities, the now Medcenter One Q&R Clinic is still in operation.

The city’s true winter extravaganza is making snow angels on the Capitol Mall. In 2007, 8,962 individuals helped Bismarck set an all-time participation record.
The city’s true winter extravaganza is making snow angels on the Capitol Mall. In 2007, 8,962 individuals helped Bismarck set an all-time participation record.

“We’ve been a very innovative hospital all along,” says Kim Long, the public relations coordinator. A scan of at least 37 “firsts” verifies the statement. Among North Dakota innovations: First to use Novocain for anesthesia, first oxygen tent, first cardiac catheterization and cardiovascular surgery, laser surgery, kidney transplant, bone marrow transplant and laser cholecystectomy. Recent “additions” include the Silver Hawk™Plaque Excision System, ActiveArm and ActiveLeg programs (improving arm and leg functions for stroke, spinal cord, cerebral palsy, and multiple sclerosis patients) and the coblation tonsillectomy technique.

He’s not the first in Bismarck, but Patricio Fernandez, MD, as a pediatric cardiologist, is one of kind. “Usually an area needs one (physician with my specialty) for every 250,000 people. I think that for the whole state, two would be more than enough, given the fact that North Dakota is an underpopulated state. Otherwise, we would be scratching for patients.” But, he adds, “Over time, if the practice grows, I think we will need another here, but not right now.”

Fernandez’s association with St. Alexius is, for him, a godsend called SAFETY, in capital letters. “It’s been a long road,” he says, of a journey that started with medical school and residencies in Mexico and included fellowships at universities in Lexington, Kentucky, and San Diego. Back in Mexico City, he and his wife, a biomedical engineer, operated a business renting high-frequency ventilators to hospitals. But it was dangerous. “My father was kidnapped twice in ten years,” Fernandez laments. With evermore violent gangs threatening those they deemed good ransom prospects, the Fernandez family said goodbye to their homeland. A fellowship in Toronto was followed by “Americanized” training in Texas.

After deliberating between Madison, Wisconsin, and Bismarck (Texas was too hot and too humid), they decided on North Dakota. “In the end, we thought that Bismarck is a lot more family-oriented.” And very, very safe. “The fact that you don’t need to worry about your safety or your family’s safety is something that should be happening in every city, but that is not the case (even) in all (American) cities.” Bismarck, however, has been named one of the United States’ safest cities by various statistical agencies. And, to Fernandez, that means “being able to walk around and not needing to worry that anything can happen to your kids.”

Another advantage for his practice and its potential is that patients who once traveled several hours to Minneapolis for treatment unavailable at home are now finding that, as Fernandez puts it, “They (still) need to travel for (heart) surgery, but not for continued care. We can do some procedures here in this market, and that is very good for the community and for the service.”

While the hot summers and chilly winters aren’t for everyone, for the residents of North Dakota, it just comes with the territory. And a lot of the time, the weather is quite nice—“North Dakota nice.”



Eileen Lockwood

Easy to Register >> Control your visibility >> 100% free

Take control of your Job Search

Recommended PracticeLink Magazine Articles