November 29, 2023 608 PM
MARFA — Marfa Country Clinic’s search for a new full-time licensed medical provider following the departure of Dr. Christie Alexander is stretching into its eighth month, prompting clinic owner Don Culbertson to explore alternative options for keeping the rural healthcare facility afloat.
“I need to find a way to continue our clinic for two reasons. Because it’s my livelihood and business, and number two, I genuinely believe Marfa needs a retail, brick and mortar operation for healthcare delivery in the town,” said Culbertson.
Culbertson, who opened the private, for-profit clinic with his wife, Valerie Breuvart, in 2010, is now seeking financial assistance from the Big Bend Regional Hospital District (BBRHD) to help with doctor recruitment and retention. He’s also considering increased telehealth services for patients in lieu of, or in addition to, a new in-person provider as well as pursuing additional patient programs in psychiatric care and Comprehensive Care Management (CCM).
“We are looking at recrafting our clinic to being a telehealth clinic or virtual clinic; that’s essentially what we’re doing now,” said Culbertson. Culbertson currently sees patients remotely from his home in Paris, France, and Dr. Marco Garcia — who grew up in Marfa and is now living in El Paso — comes into the clinic two days a week to share the workload.
Alexander left Marfa Country Clinic in July after two years as its medical director and primary provider. She said the decision to leave was extremely difficult, but the role was not financially viable and she needed to earn a higher salary in order to pay off student loans.
“It was an absolute joy working for that clinic. I loved it. I love the patients. I love the community. It was a majorly tough decision to leave,” said Alexander. “I struggled with it for a long, long time.”
Alexander took over the clinic and its patients from both Culbertson and Dr. John Paul Schwartz upon their departures in the summer of 2021. The arrangement was for a one-year position, she said, but she opted to extend it an additional year.
She said the role was, in some ways, her dream gig. “It was everything I’ve ever wanted to do –– work in a small town, really get to know the patients, be everybody’s doctor,” said Alexander. But the sheer number of patients, presence of highly-transmissible COVID variants and hard work building trust as a newcomer made the role very demanding, she said.
“I took over a large practice that serves 4,000 people that was being served by two people,” said Alexander. “I don’t know that I realized how big of a job it was going to be. To be one of the community doctors is a big thing in a small town.”
Culbertson began seeing patients remotely in Alexander’s second year to lessen the burden, but her looming student loan payments were still on her mind, she said. Unlike government-based health centers which are able to help providers with student loan payments, private clinics do not have that option, she said.
“The competition is, ‘Hey, come work for us and we’ll pay off your student loans,’ and it’s hard to compete with that,” said Alexander. “It’s hard for a Marfa Country Clinic to compete with that.”
Culbertson recognizes that the salary the clinic is able to offer for the position is part of why they are having a hard time recruiting a doctor. “Nobody wants to work really hard in a demanding environment, which requires a lot of personal responsibility and not get paid enough for their work,” said Culbertson.
Providing medical care to a sparsely populated area just doesn’t bring in the big bucks, he said. “It’s hard to make money in a rural practice,” said Culbertson. “We cannot generate the same funds as one can in a suburban or urban practice.”
The BBRHD is currently considering a proposal from Culbertson to help fund doctor recruitment and retention. Funds for head hunters, job postings, signing bonuses, retention bonuses and more would be included, he said.
According to the U.S. Department of Health & Human Services, Presidio, Jeff Davis and Brewster counties are all classified as health professional shortage areas.
Culbertson said he is advocating that non-compete clauses, legal agreements preventing the movement of workers from one facility to another within a specific area, should not be included in any contracts. “I’d like the hospital district to attract somebody to our region more than to a specific practice,” he said.
J.D. Newsom, director of the BBRHD, said the entity has helped with physician recruitment for almost all of the local healthcare providers in the past, and “long-term strategies to build a provider pipeline” for the region are underway. In addition to the creation of certified nursing assistant (CNA) programs at local high schools, the district hopes to enter into further partnerships with medical schools “to bring in med students on rotation to further expose new providers to the region,” said Newsom.
Culbertson is also looking into adding a telemedicine cart to the Marfa Country Clinic, technology which allows for doctors to perform routine check up activities — listen to patients’ hearts, lungs, look into their ears and more — virtually with the help of a nurse. The technology is already in place in Marathon at a new health center that is partnering with Texas Tech University.
Culbertson, an early adopter of telemedicine, said the technology has improved significantly due to the COVID-19 pandemic. And while face-to-face interactions may be preferred by some, telehealth is the future of the healthcare industry, he said.
“I think traditionally, rural people and/or older folks, this might not be their preference, or they might have a hard time adapting to that,” said Culberton. “But this is the way healthcare delivery is being transformed in our current age.”
Marfa Country Clinic is currently pursuing additional telemedicine patient programs in psychiatric care and Comprehensive Care Management (CCM), both of which are covered by insurance and Medicare, said Culbertson.
Psychiatric care will involve enrolling patients with a psychiatrist who will provide them with a diagnosis, help clarify medication timing and dosage and will include access to a talk therapist and case manager. CCM will assist those with chronic illnesses and more with reminders, clarifications and patient education on their continued healthcare.
“We are electing to enroll in this for the purpose of expanding the care possibilities for citizens of the Big Bend region and our patients,” said Culbertson.
Alexander, who is still living in Marfa and is now practicing telemedicine full time, said a hybrid in-person telemedicine model, like they currently have at Marfa Country Clinic, is her preference. Patients can physically come into the clinic, interact with the front desk person and have their vitals checked by a nurse before hopping on a virtual call with their doctor. They also have access to any tests that need to be performed, she said.
“More trust is built because at least they’re walking into a building seeing familiar faces before they get on the computer screen, which is much different than somebody sitting at their house talking to them on the computer,” said Alexander.