'Country Doctor of the Year' Embraces Challenges of Rural Medicine

Robert Bosl, MD, has for the past 33 years served about 2,500 patients around the town of Starbuck, MN. This annual award recognizes what is right in rural healthcare delivery, but it also inadvertently shows us much of what is wrong.

Since 1992 the physician staffing company Staff Care has honored a Country Doctor of the Year. The award is given to one physician each year, but it could easily be awarded to thousands of dedicated physicians serving rural America.

The award recognizes what is right in rural healthcare delivery. It also inadvertently shows us much of what is wrong.

On the one hand, the Country Doctor of the Year personifies the self-sacrifice of rural physicians. Many of the winners are in their 50s or older and have spend their entire careers serving generations of neighbors in small communities, often working 50 or 60 hours a week or more, in addition to on-call duties.

And that's the problem. Rural healthcare delivery has placed a staggering burden on these physicians, even if they aren't complaining about it. Many haven't had a vacation in years. It speaks volumes that the grand prize for winning the award is a two-week vacation, during which time Staff Care will supply a temporary physician.

The Country Doctor of the Year winners I've interviewed over the years say they do what they do because they recognize the need—that if they don't provide healthcare, it won't get provided. That is a big part of what keeps them going. They genuinely love their work and they get great satisfaction from it. At the same time, many of these docs see themselves as relics and say they don't blame younger physicians for wanting a better life-work balance.

The 2013 Country Doctor of the Year winner is right out of central casting for the Hallmark Channel.

Robert Bosl, MD, a decorated combat medic during the Vietnam War, has for the past 33 years served about 2,500 patients around the town of Starbuck, MN, which he describes as a real-life Lake Wobegon. According to Staff Care, Bosl, 66, a family physician, gets up at 5 a.m. every day to round his patients at Stevens Community Medical Center 20 miles away. He is usually on call seven days a week, 24 hours a day and provides a range of care, from obstetrics to geriatrics, making house calls during winters in a car with over 200,000 miles.

When the Starbuck hospital shuttered in 2005, Bosl took out a personal loan on his house and invested his life savings to build a modern clinic so that Starbuck's citizens would continue to have local care.

Did you get that? It bears repeating. When the hospital closed, he built a clinic to provide care for Starbuck's citizens, many of whom are elderly and on Medicare.

"I am kind of a dinosaur. I am not a saint but I might be something of a martyr," he says with a chuckle. "I was on call over the Thanksgiving weekend. I delivered a baby. I did a D&C. I did a colonoscopy. I did an appendectomy. I saw all sorts of extra patients just by being on call. It is something that all needed to get done. After the weekend you take a deep breath and say, 'Oomph! There must have been a full moon out.' But you just go on and it's one patient at a time, and whatever needs to get done gets done."

Bosl takes great satisfaction and pride in his work, but he also understands that not every physician is cut out for it. Not only are the hours demanding, global changes in care delivery beyond physicians' control are making times even more challenging for rural providers.

"There are outside forces that really make it difficult to do what I have done," he says. "For somebody coming out of residency, they cannot anymore go to the bank and say, 'Hey, I am a doctor. Loan me all the money you got so I can start a clinic!' That doesn't work. Logistically it is hard and a lot of the younger guys and gals coming out don't have an interest in that any longer. All they want to do is practice medicine—and yes, they do look more at an 8-to-5 job than some of us old fogies."

To encourage young physicians to practice in rural America, Bosl says the first thing he'd tell them is that they don't have to be like him and expect to be on call 24/7. What's harder, he says, is conveying his enthusiasm for practicing medicine in a rural environment. "There is no profession that is more challenging. You never know what is behind door number two. The intellectual stimulation is always going to be there," he says. "I don't recall ever leaving an exam room and feeling that I had no impact on the patient, or feeling that I didn't enjoy the encounter. Yes, there are times when a patient can be difficult. … But to actually practice medicine one-on-one with a patient is so rewarding intellectually and emotionally."

"The long hours aren't going to burn us out. Seeing many, many patients isn't going to burn us out," he says. "The problems come in with governmental intervention or more often insurance company interventions that require physicians to waste time dealing with prior authorization or medication changes—a lot of things that physicians really have the expertise to make some of these decisions. To make them take the time out from actually seeing patients to convince somebody with much less training at an insurance company to switch a medication seems counterproductive."

Bosl says he expect to continue practicing medicine until he feels he no longer can. "Especially as I am aging, people start wondering about it. 'Doc, we know you aren't going to be around forever, but how long are you going to keep doing this?' I feel like until my mad cow disease or old timer's disease kicks in and I can still do a good job, I will stick with it. When the day comes that I feel like I am losing something, that I am not as sharp as I used to be, then I will need to back off."

Bosl says he has no regrets about his chosen career, despite what others in healthcare might think.

"The prestige sometimes is fascinating. Sometimes the family doc is looked down upon as low man on the totem pole who maybe wasn't smart enough to become a neurosurgeon," he says. "Personally it doesn't bother me. I wouldn't want to be a neurosurgeon. Operating on the brain all day would become pretty boring. I wanted a new challenge every day. Financially, I do okay. I don't make what a radiologist or an orthopedist makes but I make an adequate living, and yes, I work a lot but I make time for myself. Wednesday nights I play men's league basketball. In the summer I try to get out golfing once a week. I live on a lake and I have a boat. Life is good. Every day is good."