BUFFALO — Health care facilities nationwide are experiencing a shortage of primary care physicians, and Johnson County Healthcare Center is no exception.

With the impending retirement of Dr. Mark Schueler, one of the facility's 15 providers, the Family Medical Center is hoping to fill an opening that requires primary care in the clinic, hospitalist work, emergency room shifts and care in the nursing home, according to the center's job posting.

A few weeks into the search, interest hasn’t been high and any potential candidates haven't been the right fit, said Schueler, who is also chairman of the hospital board.

“This is an unprecedented time in the last 30 years, where we’ve been looking for someone and not the other way around,” he said at a recent hospital district meeting. 

Primary care is less appealing to recent medical school graduates than specialist work, Schueler said, with more responsibility and less financial reward. 

Family care doctors in rural areas not only see patients throughout the day, keep up with latest research and deal with insurance payments and prior authorization, but they also work emergency room shifts and have other expectations as one of a few medical professionals in a region. Many rural primary care physicians also practice obstetrics, a field concentrated on pregnancy, birth and postpartum care.

The workday is not a typical 9 to 5, which leaves less time for family and can be overwhelming. Primary care providers make on average 40-percent less than specialists, according to a 2020 study by the Medical Group Management Association.

The result is a shortage in providers.

"That's a stress that many people have decided they don't want anymore,” Schueler said. “Primary care is a very important and challenging job. Most people would say, 'Why get paid less to do a hard job when people will give you more credit for going into a specialty?'"

Eric Boley, president of the Wyoming Hospital Association, said the shortfall isn't a new problem. Recently, it's been exacerbated as more doctors retire.

“Our population is aging, and there are less and less young people entering the workforce,” he said. "It's sometimes even more difficult to get them to come to rural areas, because it has to be appealing to spouses of doctors.”

Incentives that previously made practicing primary care in Wyoming an appealing option for recent graduates, including loan repayment, no longer exist with budget shortfalls, Boley said.

Possible solutions include working with the multi-state medical school, WWAMI — Wyoming, Washington, Alaska, Montana and Idaho — to emphasize the need for primary care, Boley said, or to bring in more foreign doctors through a J-1 Visa program. 

An influx of physician assistants and family nurse practitioners has helped fill the gaps.

While the hospital board is experiencing the physician shortage firsthand, the problem is nationwide. 

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.

To address that shortfall, U.S. Sen. John Barrasso, R-Wyo., recently introduced legislation to expand access to physician training by increasing the number of residency slots funded by Medicare, according to a news release last month. Barrasso is an orthopedic surgeon, former president of the Wyoming Medical Society and a previous Wyoming Physician of the Year.

The Physician Shortage GME Cap Flex Act aims to address the growing physician shortage by empowering new teaching hospitals in underserved areas to increase the number of Medicare-funded residency training slots in their programs. Under current law, there is a cap on the number of residency positions funded by Medicare.

“This situation is especially urgent in rural communities,” Barrasso said in the release. “I am proud to help lead this bipartisan effort to expand physician training in the places and specialties needing it most.”

Crystal Smith, family medical clinic director, said at the hospital board's June meeting that residents typically would fill the currently vacant role, but the students in their residencies at the center right now won't graduate for another two years.

Boley said he appreciates Barrasso's intent to improve rural healthcare and that the legislation could help to a certain degree.

“One of the biggest problems with lifting the cap is whether we have the capacity in our medical schools to increase how many students they can take and whether we can find residency and rotation slots,” he said. “It could help, but there's got to be some work done on the other end.”

For now, the search for Schueler's replacement before he retires in October continues.

“(Circumstances) are making it harder for people to choose a career in primary care, especially full-service rural family practice,” Schueler told the hospital board last month. “The model that we've enjoyed may be harder to maintain, and that's not really what we want, but that's the reality I think we're dealing with."