Etta Pederson, 92, stops by the clinic for a follow-up visit. Dr. Robert Bösl, wearing cowboy boots and a stethoscope, strolls into the examining room, checks her breathing, reviews some test results on his laptop and delivers a dose of good news.
Her pneumonia has cleared up. After reviewing her medications, Bösl puts his arm around her shoulder, commends her lovely smile and helps her up with an outstretched hand.
She smiles, well aware that her doctor — the only physician in Starbuck, a town of 1,300 — was recently named national Country Doctor of the Year. There’s a billboard with his picture announcing it along Hwy. 28 as it curls around Lake Minnewaska 140 miles northwest of the Twin Cities.
The prestigious award isn’t what impresses Pederson. Nope, it’s what he’s done to ease the irritating rash on her side.
“First doctor I’ve been to that has helped me with my itch,” she says.
Pederson’s son-in-law, who drove her to the appointment, is equally appreciative. “Having a doctor like Bob in a small community like ours is something very precious,” Norman Nissen says. “It means an awful lot.”
And it’s becoming increasingly rare to find family-practice doctors like Bösl who want to plant roots in rural America. The average U.S. doctor is 55 and the number of physicians who will retire soon far outpaces students coming out of medical school willing to work in small communities. A recent study predicts a nationwide shortage of 90,000 doctors a decade from now as loan-strapped med students opt for such high-paying specialties as cardiology and orthopedics in big-city hospitals over the do-it-all juggling acts of small-town docs like Bösl.
That’s why the Country Doctor of the Year award is extra sweet and includes more than a plaque, an engraved stethoscope and a monogrammed lab coat. The Texas-based health care staffing company that presented the award will pay the $10,000 cost to send a temporary physician to fill in for Bösl. That will allow the doctor his first two-week vacation in nearly a decade. He plans to head to Nevada to play golf in March.
‘Let’s keep it going’
Bösl (pronounced “basil”) knew he would face myriad challenges practicing family medicine in rural Minnesota when he chose to settle in Starbuck 33 years ago. But the people, the lake and the broad variety of cases all appealed to him.
“Remember that TV show when you didn’t know what was behind Door Number 2? Well, that’s the way we practice medicine here,” he said, on his way to sew five stitches into the cut flesh between a 25-year-old’s left thumb and forefinger.
He grew up about 30 miles away, south of Sauk Centre. After serving as a medic in Vietnam, he was drawn back to the area.
“I just felt there was a need out here,” said Bösl, 66, “and I could fully utilize my skills doing the appendectomies, C-sections, tonsillectomies and colonoscopies that I wouldn’t be able to perform in the metropolitan area with all those specialists around.”
Starbuck has a long history of quality doctors, dating to the 1800s. But when the Minnewaska District Hospital closed its doors in 2005, Bösl mulled retiring and walking away from a successful career. Then he shook his head.
“People retire when they no longer feel good about what they’re doing,” he said between patients. “At that time I felt good about what I was doing and felt this community deserves the good health care it’s enjoyed for many years so I thought: Let’s keep it going.”
He took out a mortgage on his house, invested his savings and literally built the clinic from scratch — even pouring his own footings on a chilly New Year’s Day nine years ago.
Now a year past the traditional retirement age, Bösl jokes with his staff that the “R” word is banned at the Starbuck clinic. But he acknowledged administrators who manage the clinic have been searching for Bösl’s eventual successor.
“You can’t just go into the grocery store and find a doc that’s willing to practice in a rural area,” he said. “A lot of people don’t feel comfortable practicing without a bunch of other doctors nearby.”
That’s what impressed the Country Doctor of the Year folks, a group from Staff Care and AMN Healthcare, affiliated national health care staffing companies that have presented the award since 1992 to physicians in communities with fewer than 30,000 people.
After reviewing a nomination sent in from Bösl’s daughter, committee members conducted a two-hour telephone conference with Bösl, then sent three members to interview him and talk to town leaders and patients. They returned to present his plaque at a recent banquet at Starbuck’s community center.
“I’m the first winner ever from Minnesota,” Bösl said. “After making two visits here in the middle of a cold winter, I wonder if they’ll allow any more from Minnesota.”
He chuckles, but there were tears in his eyes when he told his staff of eight nurses and technicians about the honor. They’ve all been with him the last nine years. Many predate Bösl’s arrival in 1981.
“We wouldn’t be here without him,” said Vicki Pieske, a lab technician. “He’s the epitome of what a county doctor should be: He’s very calming and never gets riled about anything, but he’s smart beyond any of our comprehension.”
Bösl, thin as a fishing pole and sporting a bushy gray mustache, wakes up at 5 a.m. every day. He built his house with a racquetball court and a basketball rim. He carved out a 300-yard fairway and putting green at his place on the lake, so he can practice when spring arrives.
“I derive my pleasure in short bits rather than saving up the whole year for a three-week vacation in Jamaica,” he said.
His schedule wouldn’t permit that. He’s on call seven days a week and begins each day driving 40 miles round-trip to the hospital in Morris. Lately, that’s meant squinting through blowing snow and navigating his Cadillac Escalade through subzero chills. He usually circles back to Morris every evening for a second inpatient check.
“He’s steadfast, conscientious and committed,” said Greg Rapp, a physician assistant. In his 12-plus years working with Bösl he recalls only one day the doctor couldn’t see patients. “His commitment and drive is always there.”
Last summer when a storm felled several trees on his property, Bösl chainsawed his way out of the driveway to make his morning rounds.
If Bösl weren’t in Starbuck, patients would have to go to Benson, Glenwood or up to Alexandria — a 50-mile round trip.
“That wouldn’t be a problem for young people, who would just hop in the car and go,” he said. “The problem with these rural counties like Pope County, is there are a lot of elderly here and it’s really inconvenient and expensive.”
He paints the picture by numbers. The average person sees a doctor 3.5 times a year. Take 10,000 people in the county. That’s 35,000 trips of 50 miles or roughly 1.75 million miles of annual medical commuting. At the IRS’s 50-cent-a mile-rate, that’s $875,000 a year.
Beyond the numbers, Bösl loves the broad spectrum of ailments he treats, as well as knowing other factors that might affect a patient’s health.
“We know all the gossip in the community and what people’s stresses are,” he said. “We understand relationships, who’s having trouble with a spouse or work, all of which impact someone’s health care.”
He regularly works with medical students from the University of Minnesota Duluth, which sends nearly half its young doctors to towns with fewer than 20,000 people. Many have come out and shadowed Bösl to learn the art of family practice medicine. Medical schools, he said, are increasingly keen on finding a balance in admissions by looking for students from rural areas who might be more willing to fill the void and address the pressing shortage of small-town primary care doctors.
Until then, Bösl will continue making those windswept rounds and cajoling patients whose ages range from prenatal to 90-plus.
“I would be comfortable walking away from this,” he said, “if I knew there was somebody to fill these boots.”
He glanced down at his dark leather cowboy boots and zoomed off to his next patient.