When Dr. Mark Schueler, one of Johnson County Healthcare Center Family Medical Clinic’s longest-tenured providers, announced his decision in May to retire from practicing family medicine, nobody wanted his job.
None of the few applicants who did apply for the position, which entails not only primary care in the clinic but also hospitalist work, emergency room shifts and care in the nursing home, were the right fit, Schueler said at the time. As he tells it, the lack of interest in a job in the medical profession in Buffalo is an unprecedented phenomenon. Never before has the hospital had to recruit for a new doctor, Schueler said. Potential providers would always come to the hospital looking for work.
Likely due to a desire for a more stable work-life balance, doctors looking for such jobs are no longer the case. Primary care doctors make less money and garner less glory than specialists, Schueler said, so recent medical school graduates are trending away from it. Recruiting doctors to rural areas, where they often function as a sort of “one-man band,” as Schueler puts it, is difficult, too.
Despite the challenges, Schueler, who has worked 60-plus hour weeks in the clinic, hospital and emergency room for the past 30 years, is reluctant to give it up.
“The sad part is, I don’t have patients anymore,” Schueler said last week during a lull in his afternoon working in the hospital. “I’m not anybody’s doctor.”
The healthcare center’s problems in recruiting Schueler’s replacement and his desire to lessen the burden on his colleagues has led him to stay on in a limited capacity as an emergency room physician. He’ll work a few 24-hour shifts throughout the month, cutting his hours roughly in half, he said. Dr. Erica Rinker, who was hired earlier this year to work as an emergency room physician, will take over his position in primary care.
“I thought for a long time about whether I want to take that step and tell everybody that I have taken care of, for some people, 30 years, ‘You’ve got to find somebody else,’” Schueler said. “And that’s a hard call. It’s disruptive and there’s a lot of changes people have to make.”
He mulled it over for a few months and ultimately decided to leave, giving his employer six months’ notice, in hopes that would give the clinic enough time to find a replacement. In time, the healthcare center took the job posting down, unable to recruit someone who could replace Schueler.
That six months is up on Oct. 15.
So Schueler will still come to work. And serve in his capacity as county health officer, a position that has an elevated level of visibility and responsibility amid the coronavirus pandemic. And he will chair the Johnson County Hospital District board of trustees that oversees operations of the county’s healthcare center.
That’s OK with him.
“I have a strong bias toward work. I think you’re better if you do, and I’d like to keep working,” Schueler said. “I also felt as though it was too many hours, too many days for somebody 61 years old.”
Luke Senden, the healthcare center’s CEO, is also excited that Schueler will continue to serve with the facility’s medical staff.
“If you look at the number of boards that he does serve on, he’s someone who definitely has been influential on the successive health care delivered in this county for a long time now,” Senden said. “That’s something that’s just been really evident to me, is just the amount of stuff that he’s picked up to carry that torch.”
Schueler said that he’s started to feel the burnout that so many in the medical profession are reporting after 19 months in a once-in-a-lifetime public health emergency. Anyone who seeks information from him, though, would be hard pressed to see it. The county’s foremost authority on COVID-19, Schueler delivers updates to the community with patience and an assured demeanor, even as segments of the populace deny the science behind his words and, in some cases, the existence of the disease itself.
Still, he doesn’t mention COVID-19 as a cause of these feelings. Mostly, it’s the running out of time.
“It’s interesting how you like your job and you feel like things are going well, and then you start becoming very irritated by certain things and saying, you know, ‘Why does that bother me now? It didn’t bother me a year ago or two years ago,’ and I think it’s just, more than anything, it’s not having enough time to address other needs,” Schueler said. “Work is not supposed to be a picnic, but I’ve been working 60 hours a week since I moved here — or more.”
Working in a critical access hospital in a small town isolated from other facilities is a unique situation for providers. It’s a model that suits patients — and Schueler in caring for them — but results in long hours.
If one of his primary care patients visits the emergency room, they might find him there as the physician on duty. If they are admitted into the hospital, he cares for them there, plans for their discharge and follows up.
“There was no shifting from one provider to another,” Schueler said. “It was continuity in every sense of the word, which is becoming rare. If you go to the hospital in Billings or Casper, you get one hospitalist in the morning, another one at night, and every two or three days, it’s another team. It’s sort of medicine by committee, but nobody really knows what’s going on all that well.”
On the flip side of that, patients’ reliance on and trust in their provider has made it difficult for Schueler to take a break. Even with the assistance from and support of fellow providers, he said, he often returns to work after some time off and any sense of rest is gone.
“Every time I came back, even after just being gone a couple days, I’d have about 25 prescription refill requests, six phone calls, 10 lab reports to do,” he said. “And you had to try to get that done while you were seeing people in the clinic or covering the ER. It was as if you never got away because it was accumulating by the moment.”
Schueler’s willingness to do this work is exceedingly rare among today’s providers. And the difficulty in hiring a primary care physician is not exclusive to Johnson County. A study published last year by the American Association of Medical Colleges anticipates a shortage of between 21,400 and 55,200 primary care physicians by 2033.
Senden said there is still a pool of providers and recent medical school graduates who are interested in practicing full spectrum care. Maintaining a sustainable model for the future, he said, will depend on hiring people who are the right fit.
To lessen the workload on primary care physicians and to provide more consistent care for patients, the hospital board voted last year to hire a hospitalist and emergency room doctor at the beginning of 2021, according to previous Bulletin reporting. With this model, the hospitalist makes rounds Monday through Thursday, and family care providers visit with patients on Fridays and weekends.
Currently, family care providers rotate through a schedule serving as the hospitalist.
“We have several providers that are really enjoying the changes that (the hospital) made last year through the start of this year,” Senden said. “I think we have a recipe right now that’s setting us up for long-term success.”
Schueler said he is proud of the care the healthcare center is able to provide patients, a level of care that, in the past few years, has drawn patients from Sheridan and Gillette. In 30 years, the facility has doubled its staff, he said, and there is no shortage of work for each doctor and physician’s assistant.
“I guess you can say the workload has almost doubled,” he said.
Schueler said it’s difficult to walk away from family care, but he’s ready to have more time for himself. And he will have plenty of personal projects to keep him busy in the coming months as he transitions to working fewer hours. Since fourth grade, he’s had an affinity for music, an art he said he wants to advance in during his quasi-retirement. He also has plenty of family to keep track of, including his parents who live nearby and kids who are likely to have kids of their own soon.
“I really enjoy outdoor things, and there’ll be more days when there’s new snow and I can go ski instead of going to work,” Schueler said. “So that’s kind of a selfish indulgence, but the day is coming when there won’t be the ability to do those things.”
Julie Leis, a registered nurse who worked with Schueler in the clinic and hospital for a combined 15 years, sees Schueler as anything but selfish.
“I’m excited for his semi-retirement, but I’ll miss him,” she said. “(The community) should know how much time and sacrifice he’s given to our hospital.”
So while patients won’t hear Schueler knocking on the exam room door before their annual checkup, they’ll still see him in the hospital and emergency room — and, hopefully, on the slopes.
“It’s a great advantage for me to be able to work 33 hours a week instead of 60 and still interact with people and be part of the organization,” he said. “I’m looking forward to that and we’ll see how it goes. I hope I can do it for 10 more years and not get too out of the loop.”