When you type "Marshfield, Wisconsin" into a search engine, among the top results to show up is a link to the city's official tourism website, which boasts that "Marshfield is a vibrant community in Central Wisconsin known for world-class health care."
Brian Hoerneman, MD, takes pride in that claim, and not just because he is interim CEO of Marshfield Clinic Health System, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Dr. Hoerneman is a native of Marshfield, a community with a population of 19,000 with one of Wisconsin’s largest tertiary care centers. To Dr. Hoerneman, caring for the community is personal. He also understands better than most the realities of offering care in a rural area—his hometown is a nearly three-hour drive from either Milwaukee to the southeast or Minneapolis to the west.
"Our health system's mission, vision and values are around that affordable, accessible, high-quality care in a rural environment," he said. "Growing up in a rural environment and understanding our community has really given me a good perspective on what our communities need and how we can meet the needs of patients and continue to improve on that over the years."
Dr. Hoerneman spoke about meeting those needs in a recent episode of “AMA Update.”
Providing care where it's needed
Dr. Hoerneman is an emergency physician, and his work within the Marshfield Clinic Health System dates back nearly 20 years. During that time, he's seen changes to his hometown—changes that mirror many rural areas across the country.
The population is getting older—that leads to an increased prevalence of chronic illness—and it also is declining, according to the U.S. Census Bureau. Residents have also faced economic challenges. According to the Census Bureau, more than 12% of Marshfield residents live in poverty, which is higher than the national average.
The health system serves more than the city of Marshfield—its more than 1,400 physicians and other health professionals offer care across 50,000 square miles across rural Wisconsin and Michigan's Upper Peninsula. Despite Marshfield’s nearly 60 medical clinics, living in rural areas may still require patients to drive more than an hour to access one of the system's clinics or hospitals.
"Those things combined together with limited access to primary care and specialty care, all of those compound and make it really challenging for those patients who are living in a rural geography to get the care that they need," Dr. Hoerneman said.
To offer more accessible care, Dr. Hoerneman said he and his colleagues are considering any number of options, from telemedicine and in-home care to opening closer clinics or having traveling specialists.
The key is not being comfortable with the status quo because "we do have to think differently to meet those patient needs," he said.
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Finding a like-minded partner
Dr. Hoerneman himself is an example of not doing things how they always are done. Despite his interim CEO title, Dr. Hoerneman continues to practice in the emergency department. He said it is a great way to interact with his colleagues and get a better picture of the challenges they face.
One such example is understanding the EHR.
"You can go to meetings, you can round with providers, you can get a pretty good sense of how the program works from those sorts of activities," he said. "But until you've used it firsthand, it is difficult to get a full sense of it and understand where some of the opportunities are."
Continuing to practice allows Dr. Hoerneman to focus on physician needs, but as interim CEO, he also has to keep the interests of the entire system in mind. That is why he is excited about Marshfield Clinic Health System's intended merger with Sanford Health, also an AMA Health System Program member. The merger was announced in July and is expected to be completed before the end of the year.
At Sanford Health, which serves Iowa, Minnesota, North Dakota and South Dakota, Dr. Hoerneman sees a health system with similar values and similar goals.
"If you look at what we're trying to accomplish—meeting patients where they're at, giving high-quality care in that rural geography—Sanford very much does that," he said. "With the two organizations coming together, I really think we have the opportunity to innovatively lead that rural health care push."
The AMA has developed policy to address the rural physician shortage. Many of the interventions the Association is calling for start in medical training.
Among the policy’s aims is to work with stakeholders in medical education “to consider adding exposure to rural medicine as appropriate, to encourage the development of rural program tracks in training programs and increase physician awareness of the conditions that pose challenges and lack of resources in rural areas.”
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