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Rural Health Champion

By Edward Araujo, Managing Editor, Arizona Physician

Photography by Ben Scolaro, scolarodesign.com

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From Print Issue - Summer 2021

 

She does not wear a white coat. She does not always carry a stethoscope in hand. Yet she is packed with an infectiously warm smile and enthusiasm for her community. Holly Rooney, MD, is truly a rural health champion. She leaves you with a lasting impression of fealty to her community.

Nestled an hour and a half east of Phoenix, the trip to Globe hits you with a 10-12 degree drop in temperature as you weave your way through two-lane canyon roads onto its higher valley. With a population of 7,348, Globe is a mixture of 21st century fast food joints and the Old West, as several buildings from its founding in 1875 dot the nearby hills.

 

There, one street above the old historic district stands the Chrysocolla Inn and its beautiful gardens. This bed & breakfast has been completely renovated over the last eleven years by owner/operator Holly Rooney, MD, and her mother Rosemary Rooney. They have owned the bed & breakfast for 21 years and operated it for 11. What may have once been a late-19th century brothel for gunfighter Doc Holiday’s common-law wife Mary Katherine Horony-Cummings (a.k.a. Big Nose Kate) now has seven rooms and takes you back in time.

 

A rural beginning

Dr. Rooney grew up in Globe. She attended University of Arizona for her undergraduate studies. Majoring in English and minoring in both French and biology, medicine was not on her mind until she took a genetics class. The one class spurred her enthusiasm and Dr. Rooney matriculated at the University of Arizona College of Medicine in Tucson.

 

After selecting family medicine as her specialty, Dr. Rooney completed her residency at the University of Nevada – Reno. Yet, she longed for Arizona. She had a choice: Tucson, Oracle, or Globe. Michael Durham, MD, a local physician in Globe, helped push Dr. Rooney back to her hometown. He would go on to become a mentor and consultant to her as she began her career.

 

Dr. Rooney started as a sole practitioner, moving her office from time to time. Then, an opportunity came to merge her practice with a physician assistant she was already supervising. Their joint venture led them to purchase their own building. The result was Hope Family Care Center, LLC, one of the largest medical practices in Globe. The building was originally a Sears building in the 1950’s and was completely renovated by Dr. Rooney’s husband in the historic district of Globe. In addition to the practice and owning the bed & breakfast, Dr. Rooney recently became the Medical Director of THEMA Health Services in Globe-Miami.

 

What draws physicians to rural Arizona

Dr. Rooney initially chose rural Arizona because of all the outdoor activities she could do. As she grew as a doctor, Dr. Rooney’s perspective changed. It helped to speak with fellow physicians, medical students, and other practitioners who were not from Globe. She found that “community integration” is something that happens more in rural settings than in larger cities and draws physicians to small towns like Globe.

“I live here. I work here. I feel I know my patients, many of them…most of them, really well.”

That sense of community is displayed in the fact that she frequents her patients’ businesses just as much as they frequent hers. In most cases, Dr. Rooney grew up with her patients. Now their children, parents, and relatives have also become her patients. That makes her feel even more connected to her town. That is a draw you cannot usually find in the city. “That sense of community integration leads to better patient care,” she states. Dr. Rooney also has continuity, in which she sees her patients not just once or twice but in many cases over their lifetimes. She has built patient relationships that became friendships and help to make her an integral part of Globe’s community.

 

Work and life are always close for Dr. Rooney. She begins her day by checking in with her cousin who manages the Chrysocolla Inn. After exercising, she heads to her office, which is a block and half away from the bed & breakfast. Home is just a few blocks further. Not much in Globe is more than a walk or short drive.

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Not all is bliss in rural medicine

Dr. Rooney’s day-to-day does have similarities to practicing in bigger towns or cities. Some patient care takes a back seat to the time required for medical charting, which has become more extensive over the years. Dr. Rooney maintains a full schedule of patients on Tuesdays and splits Monday and Thursday between patients and charting. The rest of her week is taken by a new role in hospice, or anything needed at the bed & breakfast, a labor of love.

 

Aside from charting getting harder each year, Dr. Rooney is frustrated by specialties that are not available in Globe, making it difficult to search for the needle in a haystack for patient referrals. Mental health is a good example. There is one behavioral health group in town, but they only serve patients with Medicaid. Dr. Rooney often recommends patients to eastern parts of Maricopa County, like Mesa. That is still a long drive, but Tucson is even further.

 

Health system analysts cite less access to care, insufficient staffing, and a lack of cultural understanding as just a few issues holding back rural Arizonans from seeing improved health care. Dr. Rooney believes staffing is a huge problem. It comes down to whether a doctor is comfortable either permanently moving to a rural area or commuting several days a week. Dr. Rooney states, “Access to care is improving but could get better if more specialists would be willing to come up at least once a week or two. They would realize what a gem it is working with patients who are integrated with the community.”

 

What keeps docs rural

What makes Holly Rooney a good rural doctor?

 

Maybe we should determine what characteristics a rural physician needs to be successful in Arizona. First, you manage more areas of a patient’s health compared to family practice or internal medicine in the city. Physicians in family medicine must get comfortable with managing a lot of issues without direct consultation with the specialists. Physicians must be comfortable dealing with a shortage of their peers. Globe currently has five primary care physicians, with one leaving soon. Yet, Dr. Rooney states, “At least four of the five have some form of connection to small town America,” giving hope for towns like Globe to retain them.

 

Second, physicians considering rural health should appreciate the opportunity for independence. Dr. Rooney can decide her own schedule. Doing so is not as common in larger settings.

 

Third, practice ownership is another factor that can keep physicians in rural health. With her name on the line, Dr. Rooney says she is more driven to deliver quality care for patients. On the financial side, going the extra mile is very important and rewarding because you earn what you put in.

 

A successful practice amongst hospital networks

Hope Family Care Center plays a pivotal role in Globe. Dr. Rooney’s practice has the largest number of patients in town. Her business partner, physician assistant Chad Campbell, offers integrative medicine and diabetes education. Chad is the business engine, providing creative ideas to recruit patients throughout the area.

 

Although Dr. Rooney did not mention pressure to sell her practice, she is aware of the local hospital’s interest in primary care practices. Two other practices have already sold with a third considering it. Dr. Rooney states, “The natural evolution of aging physicians is that patient record maintenance is so much harder now. Physicians in private practice, as they get closer to retirement, don’t want to deal with the upkeep of records, so they’ll sell.” Plus, higher compensation also pushes older physicians to a hospital as those ancillary services they were already outsourcing can now be fully compensated.

 

Telehealth during & post COVID

“Physicians are getting more and more comfortable with telehealth,” states Dr. Rooney. Some of her patients live on the outskirts of town, in the Roosevelt Lake area or Tonto Basin. They have trouble with mobility. Even though most patients have returned for in-person consultations, Dr. Rooney is confident telehealth services will remain and be useful for lab follow-ups, among other services.

After the COVID-19 pandemic subsides, Dr. Rooney hopes to leverage telehealth to access specialists working outside of Globe. Patients with poor Wi-Fi access at home will travel to her office to connect with specialists in a safe place.

 

Recruiting physicians to rural Arizona

Dr. Rooney believes loan repayment programs through hospitals or organizations like the National Health Service Corps or University of Arizona’s primary care program are great tools to encourage physicians to relocate to a rural underserved area. Using a similar program allowed her to repay student loans within five years after graduating medical school.

 

Dr. Rooney believes that Globe is not always awarded loan repayment opportunities because the ranking system and the monies available to these programs may be inadequate.  Certain factors in the ranking system make Globe fall lower on the scale, so only at certain times over the years has it been able to access the designation with its repayment opportunities. That means there’s then less interest in medical students choosing Globe or towns like it.

 

Improving funding for rural schools will help, as well. Dr. Rooney knows colleagues with children who do not want to uproot their families from a city and take the chances at what may be perceived as lower quality schools.

 

While virtual continuing medical education is common for rural physicians, Dr. Rooney would like to see more in-person opportunities offered locally, as driving either to Phoenix or Tucson gets expensive and time consuming.

 

Finally, access to capital is another aspect of rural medicine that should be reformed. The few physicians in Globe have more difficulty accessing business loans for their practices or other business ventures.

“I get up in the morning and go kayaking in the lake close to my house, then I’m back in time to work in the afternoon.”

 

The pitch for rural Arizona…Globe

I asked Dr. Rooney for an elevator pitch for Globe. She states, “Well I get up in the morning and go kayaking in the lake close to my house, then I’m back in time to work in the afternoon.” She encourages physicians to keep an open mind to the possibilities in rural Arizona. She is confident they would enjoy Globe, as it is well-positioned between Phoenix, Payson, and Tucson. There, you will find the White Mountains, Roosevelt Lake and Apache Lake, and a lot more greenery than in urban areas. The altitude provides longer spring and fall seasons. Patients are diverse and nice and want to get to know you and what makes you tick. She says, “Globe gives you a small-town feel, and you will enjoy it. There is a niceness about it not many other places have.”