RANGELY I After five years in Pueblo, completing his residency and working in the Centura Health system, Rangely District Hospital (RDH) physician Casey Aguirre is starting to get the feel of a smaller place.
“You get a little bit less red tape and you can have a more hands-on approach,” said Aguirre, who came on as the hospital’s doctor of osteopathy (DO) last month.
“As much as you want to be efficient and see patients, I also think you get a little bit more time in a smaller community because you’re not seeing quite as many patients per day.”
While Dr. Aguirre has more time for appointments than he’s used to, the learning curve of a rural, critical-access facility has been time-intensive so far, from seeing patients in the clinic to making in-patient rounds and responding to the emergency room.
But once Aguirre’s wife, Ashley, and their three boys, Jackson, Grady and Kasen, arrive this summer, he’ll strike the right balance between home and work. That was critical for him at Centura Health, while a resident at Southern Colorado Family Medicine and as a medical student at the Lake Erie College of Osteopathic Medicine (LECOM) in Erie, Penn.
“The thing that will work for me is that I’ll have my boundaries,” he said. “The most important thing for me is family, regardless of what work is. Without being happy going home, what’s the point of even working? And we’d like to raise our kids in a small town. They love the outdoors; I think it’s an opportunity for us to see if it works.”
Downhill skiing, camping, biking and hiking are among the activities that get the Aguirres moving. And while Ashley is a trained teacher with an early childhood education degree, her time, too, is primarily family-based, especially now that she’s expecting their fourth child.
For Aguirre, the challenge — and pleasure — of medicine lie in helping people take responsibility for their own health. Much of that happens in prevention, before health problems begin or progress.
“I love preventative medicine; you don’t see it enough,” he said. “Diabetes, for instance, is a disease I like to manage because I’ve seen it so much. I tell people that uncontrolled diabetes is worse than HIV. It’s just so bad.”
Rather than dictating their care, Aguirre encourages patients to educate themselves about ways to get and stay healthy.
“I come from the standpoint of tough love when I teach people,” he said. “Somebody will come to me and say, ‘What do I eat?’ and my response is, ‘Your assignment is to go to the library, check out three books on diabetic dieting and tell me what you need to eat and don’t need to eat. Because if I tell you what to do, you’re just going to put it on the fridge and not do it. But when you do it, maybe it’s going to stick.’”
While family practice may be a natural fit for Aguirre’s training in sports medicine, pediatrics and geriatrics, among other interests, a big part of his job now is just observing, taking time to better understand the hospital’s culture and relationship within the community.
Low clinic numbers are one thing Dr. Aguirre hopes will shift over time as doctors Karyl Ting and Tim Hsu get more regular support from himself and providers Shelby Lindsay and Katy Rieves.
The hospital has struggled to offer regular care providers for more than a year, after Dr. Mercedes Cameron left the hospital nearly 18 months ago to undergo cancer treatment, and Dr. Chris Adams resigned last June for personal reasons.
Bringing in locum tenens, or fill-in, physicians to cover those gaps meant that patients often saw several different providers for their ailments.
“I think that in the next year, having Shelby, Dr. Rieves and myself here — pretty much two or three of us here every week — should offer some stability,” Aguirre said. “I tell patients, ‘You should be able to see one of the three of us if you’re willing to wait a week or so, always.’ That’s something that’s important to me, that you’ll always see the same person if you want to wait a little longer, be a little patient.”
Aguirre also hopes to have more clinic time in the future than his current two days per week, a shift that could average out to several dozen more patient visits each month. And although he’s not pushing for large-scale change, being the new man on staff, he has some ideas for how Rangely Family Medicine might evolve.
One is adding practical services, like appointments reserved daily for acute patients. Others are more subtle and long-term, like figuring out how to direct people’s personal and professional interests in positive ways.
“It’s a little bit different here; things get magnified really quickly and interpreted differently,” he said. “I think the thing I’ve observed is that when you have a community that really cares about this hospital and has put a lot of effort and sacrifice to make it possible, you also have people in the hospital who are a part of this community … it gets a little hard for people to know where the personal and professional levels divide. You don’t see that as much in bigger hospitals because you’re not really hanging out with the same people you’re working with.”
Proving to the community that Rangely Family Medicine can provide a breadth of care services should continue to be a main goal of RDH, Aguirre said.
“There are a lot of things we treat; I feel comfortable doing any type of pediatrics to adult medicine to geriatrics,” he said. “If we don’t feel comfortable, we’ll consult. But the majority of the population we see are healthy young kids who need well-child checks and people with earaches and sore throats. We should be more than capable of seeing those patients rather than their having to go to Vernal or Grand Junction or somewhere else.”
Getting people to come or return to the clinic, he believes, will mean figuring out what the community wants, then keeping the aspects that meet those needs and changing or improving those that don’t. That’s no overnight process, Aguirre said, and real change often happens in increments, not leaps. But as long as he sees movement toward growth and improvement, Aguirre plans to be on board.
“I’m fine with progress as long as we’re going the right direction,” he said. “If I see we’re stagnant and not caring, that’s when I’m going to have issues. It’s not huge overhauls you need; you just have to do fine-tuning and tweak things over time. That’s the problem with health care: everybody thinks you need to have these huge overhauls.
“But there are different ways and styles to do health care in every single clinic,” Aguirre said. “You just have to figure out the ways you need to do it for your community.”