Country Doctor Not Motivated by Dollars
Vietnam War Veteran Feels a Deep Commitment
Every weekday morning, Bösl wakes up at 5 a.m. and drives 20 miles to the nearest hospital to do his morning rounds. Then he makes the long drive back home and treats patients all day, sometimes into the evening hours. It’s a grueling routine, but Bösl, a highly decorated Vietnam war veteran, says he feels a deep commitment to the residents of Starbuck, a tiny Minnesota town (population: 1,302) nestled against Lake Minnewaska.
Bösl has been the only doctor in town since 1982, and in 2005, when the local hospital shut down, he took out a loan on his home and invested his life savings to build a modern clinic to ensure Starbuck’s residents would still have local care.
Thanks to his selfless dedication to his community, Bösl has been named StaffCare’s 2013 Country Doctor of the Year, an award that recognizes the “spirit, skill, and dedication of America’s rural medical practitioners” in communities of 30,000 or less.
Dr. Bösl spoke with Parade.com about the most rewarding parts of his job, what it’s like treating close friends and family (he delivered three of his own grandchildren), and the future of country physicians in America.
You invested your life’s savings to build your clinic. Why was it so important to you to have a local clinic in Starbuck?
“It’s one of those emotional things. It was a decision made through my gut…[I said], if we don’t have a clinic in town here, there’s a lot of Medicare patients here and a lot of them do have difficulty getting out, especially in winter time. They don’t want to go to the big city with 3,000 people in it; they’d just as soon get care locally…Could I have retired and gone golfing instead or something? Could I have just gone to any number of communities? Sure I could have, but it was just kind of an emotional commitment to the community to continue to have health care here.”
General practitioners are in decline around the country as more doctors enter more lucrative specialized fields. At any point, were you tempted to go that route instead of staying local?
“Super specialization tends to be more financially lucrative but professionally, it wouldn’t be as lucrative. I was not motivated by dollars as much as some of those higher moral things about helping society. Also…I think mental challenges of family medicine are just so much more than in any other profession…and I think some physicians are kind of scared off by that. I know one orthopedist in the area who was a family doc for three years and he said, ‘I can’t know it all. I’m just not smart enough to know all this.’ So he went back and did an orthopedic residency. I never really thought about that…in the end I decided I needed to make my major focus taking care of patients.”
What’s the most rewarding part of your job?
“The most rewarding part is just helping patients to a better level of health. If someone has pneumonia, I give them antibiotics…But if they have pneumonia and I know it’s related to the fact that they’re a smoker or that they’re overweight, I’m going to try to address the lifestyle changes that can decrease their risk of illness in the future. Sometimes it’s just small steps.”
Is it true you once had five generations of patients admitted to the hospital at the same time?
“I had mom who delivered a baby, and then the baby’s grandma was in the hospital with heart problems. The baby’s great-grandma was in with a respiratory problem, and then the great-great-grandma was in with some heart problems. She was in her 90s.”
Is it ever a challenge to separate personal relationships with patients from their treatment?
“I haven’t felt it that way…That’s always been one of the concerns of medicine, that if you’re too close to somebody, that it might affect your thinking. Personally, I took out the tonsils of two of my kids, and I actually delivered three of my grandkids. I have such a close relationship with so many of my patients. I mean, they’re people I see on the street every day, or I play basketball with them or I golf with them. I think if anything, [because of] that close personal relationship, I get to know who they are as an individual, what their values are, and I try to tailor how I treat them with who they are as an individual.”
Since you began practicing in Starbuck, have the town’s demographics changed?
“When I first went into practice, I was delivering 20 or more babies a year, even in a small community. Now, that’s more like four or five. It has just become a more Medicare-populated community, and a lot of that has to do with changes in agriculture. Thirty years ago, everybody used to have a 160-acre farm, and they’d milk the cows. Now, I can drive 20 miles to the hospital and not see a Holstein cow. The farms have become more soybean and corn farms, and instead of 160 acres, it’s more like 5,000 or 10,000 acres. So in a rural area, or just outside town, the population has really thinned out.”
Looking down the road a few decades, where do you see the future of the rural doctor in the U.S.?
“I think there’s still a great demand. The population here is aging. Often there are many chronic problems and they do need to be seen more frequently. Getting medical students into family medicine is very challenging, and some people aren’t up to that challenge. The ultimate income a physician has is perhaps less. But I think above and beyond all that, the frustrating parts of medicine are worse in family medicine. Insurance companies are looking over your shoulder to see if the doctor is doing everything right. ‘Are you treating diabetes like you’re supposed to, are you telling them to quit smoking?’ In family medicine, a typical doc may see 20 patients in a day and unfortunately, up to half of those, you’re going to hear from insurance companies about, you know, ‘Why did you pick this pill, why didn’t you pick a cheaper pill?’”
Speaking of insurance, has the Affordable Care Act been a hot topic in your community recently?
“It has…In a lot of ways, it probably doesn’t affect my practice a lot because there are a lot of people already on Medicare or medical assistance, Medicaid. [But] there’s one family in particular I’m thinking of in which both parents are self-employed and they have applied for Obamacare. They’re going pay less than $200 a month for a family of five for some pretty good insurance. So for them, it’s going to work out really well.”
Anything to add about being named Country Doctor of the Year?
“I think I’ve done a good job, but really I could not have done it without my wife—my wife is also a nurse—and without the support of the staff of the clinic and the hospital, and without the community support. The community is a very caring community. There’s a lot of serving, let’s put it that way, where community members really do all they can to make life better for other people. And in that kind of environment, I’ve been really fortunate. It’s been really easy to dedicate the hours I do to everybody’s health care.”
If the president invited you to the White House because of this award…
“…we could talk about [Obamacare]. But…I think I’d be more interested in just playing him one-on-one in basketball. Because even though I’m 20 years older, I think I could still beat him!”