Doctors on the open range hard to come by

BRUSH – Marc Ringel, M.D., grew up in Chicago but eventually found his way to this rural northeastern Colorado town of about 5,000 where he practices family medicine.

Ringel first came to Yuma, Colo., in the late 1970s to begin his medical career and later helped develop the Rural Training Track program under Banner Health’s North Colorado Family Medicine residency program. For him, the wide-open spaces of northeastern Colorado are a familiar and beloved landscape.

“I love rural practice,” Ringel said. “I know my patients well and I love country people. It’s the relationship with good, solid people that makes this job most worth doing.”

Phoenix-based Banner Health, which owns and operates hospitals and clinics in Northern Colorado including North Colorado Medical Center in Greeley, McKee Medical Center in Loveland, Sterling Regional Medical Center and East Morgan County Hospital in Brush, started the North Colorado Family Medicine residency program in 1974.

One major focus of the Greeley-based program has been to train and provide family health-care professionals in underserved rural areas of Northern Colorado. That led to the creation of the Wray Rural Training Track based in Wray in 1992.

Dr. David Smith, the program’s director, said the North Colorado Family Medicine residency prepares family care practitioners to practice anywhere.

Filling rural niche

“The program here in Greeley has a very unique niche in preparing people to practice in basically any community they choose,” he said. “The vast majority – over 60 percent of our grads – have chosen to practice in very rural locations, places like Holyoke and Haxtun and Wray.”

And that’s a good thing, because supplying quality health-care professionals in the far-flung reaches of northeastern Colorado is not an easy task. In some counties in the northeast corner of the state, the numbers of health professionals serving huge areas are thin and not growing.

For example, 550-square-mile Sedgwick County has only three active licensed physicians and only one dentist providing services to about 2,700 people. Those numbers did not change between 2004 and 2007, the latest years of data accumulated by Colorado Health Institute.

The situation is better as you get closer to the Front Range, but even towns like Wellington just north of Fort Collins struggle to hold onto their caregivers. The town recently lost its only family practice physician when Cheyenne Regional Medical Center decided to close Wellington Medical Center in a cost-saving move.

Fort Collins doctor John Bender and Miramont Family Medicine came to the rescue and opened a clinic in town earlier this month where Miramont physicians and Red Feather Lakes family physician Janice Weixelman will work in rotation until a new doctor can be hired.

But the problem of serving rural Colorado communities with locally based health care will continue to be a thorny one as fewer doctors choose to become family practice physicians, opting instead for a more lucrative and less time-consuming specialty practice in a more urban setting.

Then there’s the lifestyle adjustment. Just about every doctor got his or her education and residency training in a city environment and probably came to enjoy the perks of city life, with its social, recreational and cultural amenities.

East-plains fishbowl

Living one’s life in the fishbowl of a small town can be daunting and too much for many would-be rural physicians. Even Ringel notes it can sometimes be difficult, even after years of practice.

“The hardest thing about rural practice, especially for an ex-urbanite like me, is the lack of anonymity,” he said. “In any small town where I’ve practiced, it’s been nearly impossible to stop being Dr. Ringel and to be just plain Marc, to drop by the grocery store to pick up a carton of milk, for example, without having to chat with someone about their cholesterol.”

Colorado recently began intensifying its efforts to recruit rural doctors through the Physician Loan Repayment program launched by the Colorado Health Foundation. In 2008, its first year, a total of $2 million was awarded to 18 physicians who agreed to commit to three years of practice in an underserved rural or urban setting.

Under the program, physicians are eligible for up to $50,000 each year of the three years they commit to an underserved community for a total of $150,000 to help repay their student loans.

Debra Thomas, a spokeswoman for the Colorado Health Foundation, said one of the program’s goals is to get doctors acquainted with rural practice and maybe decide it’s their calling.

“For a resident who may be on the fence about practicing in a rural community, this may be what it takes to get them out there,” she said. “Most of them will leave but some will stay, and that’s important.”

Steve Porter covers health care for the Northern Colorado Business Report. He can be reached at 970-221-5400, ext. 225 or at sporter@ncbr.com.

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