Optimism abounds in Wyoming’s health care system

Continuing shortages

Josh Hannes, vice president for the Wyoming Hospital Association (WHA) noted Wyoming continues to struggle with high labor costs. Positions across the health care system — from nurses and IT to finance and food service — remain difficult to fill.

“Statewide, Wyoming has not fully come back to pre-pandemic levels of staffing. Many facilities are still relying heavily on traveling nurses and other health care professionals,” Hannes said.

Unfortunately, similar to many health care facilities in the state, the Fremont County hospitals rely more on traveling nurses than they would like to. John Whiteside, CEO of the SageWest facilities in Riverton and Lander, said recruiting nurses to the area remains a challenge, since there is a shortage of affordable single-family homes and apartments.

Whiteside noted the most difficult-to-recruit physician specialties are OB-GYN, ENT and urology, the three areas most required by younger and aging populations. He added that laboratory personnel nationwide also are in short supply.

“We are doing fair in our ability to staff our laboratories, which, in this climate, actually translates to great,” he noted.

Robin Roling, chief operating officer of Cheyenne Regional Medical Center (CRMC) and Cheyenne Regional Medical Group (CRMG), said that while CRMC’s contract labor costs have decreased, they remain higher than CRMC’s historical pre-pandemic averages.

“This is an area that we continue to address,” she said. “Reimbursement from payers, including Medicare and Medicaid, is an area that requires ongoing attention to ensure that we can continue to provide certain services.”

CRMC continues to have a turnover rate below the national health care average during this time, which has been called the era of the “turnover tsunami.”

“Our staffing efforts focus on taking care of our employees by understanding the needs of both newer and long-term staff. Plus, as the only Magnet-status hospital in Wyoming, we are fortunate to have terrific nursing staff,” Roling said. “Our health system’s chief nursing officer/vice president of clinical services, Tracy Garcia, has also worked to develop innovative programs that are helping us attract nurses. This includes a nurse residency program and a paid student nurse internship program.”

One of the concerns noted by Hannes related to staffing is the nationwide issue of violence in the health care workplace. Facilities are struggling to become safer places for their employees by providing training on how to de-escalate a volatile situation and installing more security measures, such as metal detectors and personnel.

“During the pandemic, Wyoming received over $8 million under the COVID-19 Health Disparities Grant. Facilities were able to utilize these funds to create isolation patient care rooms and update their HVAC systems. However, those funds cannot meet all of the need of the state.”

Hannes said there are positives to be found, despite all the state has been through.

“Governor Gordon has done a good job of deeming workforce development as important. He has affirmed increased educational and training opportunities are a top priority. Our goal is to find ways to keep people working in Wyoming. We want our facilities to be a welcoming and inviting place of employment,” Hannes added.

Recruiters capitalize on Wyoming’s outdoor culture

“At this time, we aren’t looking to add new services or to significantly expand our existing offerings, but rather to stabilize the services we currently provide,” Whiteside said. “We have been able to do this by recruiting physicians who are interested in practicing in rural areas.”

SageWest has recently hired two physicians, one who is trained as an OB-GYN and another who is a family practice physician with an OB residency, both of whom will start in 2024. Whiteside said this will help to stabilize the practice of OB-GYN in the Fremont County area. They also have been able to hire new leadership, including a new chief nursing officer.

Whiteside explained their success in recruiting these and other health care providers relates to several factors. First, SageWest endeavors to capitalize on their “niche” location. Situated at the base of the Wind River Mountains, Fremont County boasts an outdoor culture, with hiking, rock climbing, water sports and cross-country skiing widely available for the outdoor enthusiast. People who gravitate to the area are interested in taking advantage of the proximity of the mountains and public lands.

“I tell personnel we are recruiting if their favorite pastime is shopping at high-end, luxury stores, then this isn’t the place for you. But if you love clear skies and wide-open spaces, you might be a perfect fit,” Whiteside said.

“Another draw is that the newly recruited physicians will be employees of SageWest Group. People go to school to learn how to practice medicine, not how to run a business. This model appeals to the younger physicians who want to work their shift and leave the business decisions to someone else,” Whiteside said.

Growing our own

Because recruitment of physicians continues to be a challenge, two of Wyoming’s efforts to “grow our own” personnel are essential. WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) has been an essential part of Wyoming’s ability to educate local students for a career in medicine.

Students spend 18 months at the University of Wyoming campus in Laramie and then transfer to WWAMI’s main campus in Seattle. From there, they receive training at a variety of health care sites throughout the five states.

“This program has been a light of hope to incentivize students to return to Wyoming and care for Wyoming’s population,” explained Sheila Bush, executive director of the Wyoming Medical Society.

A second essential program is the UW Family Practice Residency Program, which was funded by the Wyoming Legislature in 1975 to address the critical shortage of physicians in the state. The Casper site was the first to open in 1976, followed by Cheyenne’s in 1979. A third site currently operates in Laramie. The program is a three-year intensive training program for graduates of medical school who have chosen family medicine as their specialty.

The value of the Residency Program is physicians learning to be comfortable practicing in rural and frontier areas, where large systems of backup care are not readily available.

Bush explained a recent innovation in the UW Residency Program was embedding a resident into a rural community for most of their program. Thermopolis was selected as the first site for what has been named the Thermopolis Rural Training Track. Dr. Megan Olson is the first graduate of the program and continues to live and work in the Thermopolis community as a physician and UW faculty member.

“Various options are being explored to find a sustainable source of funding so the Rural Training Track might be expanded to other Wyoming communities,” Bush said.

Innovation spurs hope

Bush reported some of the health care facilities and practices in Wyoming are using innovative approaches to help solve some of the staff shortage issues. As an example, she cited the vision of Tim Thornell, president and CEO of Cheyenne Regional Medical Center in Cheyenne as having a positive impact on recruiting medical students to CRMC.

“Tim understands the necessity to invest early and foster relationships with medical students. This attention promotes a relationship with the community and medical family that results in the students wanting to return to Cheyenne after they complete their residencies,” she said.

Bush sees the implementation of the Collaborative Care model as another reason for optimism in the state. This allows for one specialty provider to be attached to a health care practice, clinic or facility and offer a consultation with a provider who already has a working relationship with the patient. If needed, this specialist can provide direct services, if necessary.

Bush offered the Cheyenne Children’s Clinic as an example of the Collaborative Care model.

“The group recently hired a child adolescent psychiatrist, Justin Romano, MD, to serve in this capacity. Families now have enhanced access to mental health care. These and other changes will benefit Wyoming over time.”

New services enhance a community’s care

Roling said, “We are always optimistic about the opportunity to provide care and improve wellness in the communities we serve. We are also grateful for the support we received this past year, and for the wonderful employees and providers who care for our patients and have helped us achieve many of our goals and accolades in 2023.”

CRMC and CRMG have seen the addition of a new intensive care unit and a new PET/CT machine in the past year. Future plans include starting construction on a new Wyoming Orthopedics and Sports Medicine clinic. New health procedures and technologies include the SPRINT Peripheral Nerve Stimulation (PNS) system, a minimally invasive and nonopioid neurostimulation device used to treat acute and chronic pain.

“This system has demonstrated significant and sustained improvement in patients’ pain and function, and is fulfilling a critical need in our community and region,” Roling said.

Cardiac Contractility Modulation (CCM), which helps improve the quality of life for patients with heart failure, is another new procedure involving an implantable device that delivers precisely timed electric pulses that increase the heart’s contraction, or squeeze. Better contraction equals better perfusion, and better perfusion equals increased energy and decreased shortness of breath.

CRMC has earned the distinction of becoming the only hospital in Wyoming with a certified sepsis program, indicating that the facility meets the highest standards of care in the treatment of sepsis, and has achieved “Digital Health Most Wired” recognition for the 10th year in a row.

A bright tomorrow

Whether you are the eternal optimist or the eternal pessimist, the evidence is clear: Wyoming is slowly recovering from the devastating effects of the pandemic. Staffing is increasing, physician recruitment is on the rise, and facilities are investing in new services.

As Whiteside summarized it, “Our desire is to provide the best hometown services possible to our community. We strive to be better today than we were yesterday. It is an exciting time. We feel we are in a good place, with younger providers and new leadership becoming the lifeblood of our quality, hometown care.”