It can be challenging to operate a hospital in a small community even at full staff.
But as one small hospital in Southeast Nebraska prepares for a brief future where they'll be without two primary providers, they've identified three key areas of focus.

Jefferson Community Health & Life is a regionally recognized Critical Access Hospital. But it's the only hospital in Fairbury, and, soon, it will be without two of its primary healthcare providers.


Dr. Craig Shumard has been with the clinic since 1989 but was recently dealt a serious medical diagnosis that's forced him into medical leave. And last week, Dr. Brett Wergin announced his plans to move to a clinic closer to home in Lincoln after seven years serving patients in Fairbury.

Holly Wolff, who's less than a year into the role as the JCH&L CEO, says that second piece of news triggered her team to go into "activation mode".

"[We're] making sure we have that coverage in the clinic, the ED and inpatient, and the rest of the medical team here, the rest of our advanced practice providers, and our other physicians that are on in a part-time capacity have all really been stepping up to fill any of the coverage that we need right now," Wolff said this week.

At this stage, Wolff said her hospital has identified three primary areas of focus: ensuring existing patients still have access to the healthcare coverage that they expect, supporting the employees that are sticking around during this time of transition, and working to reinforce the hospital's roster by ramping up recruitment efforts, preferably by finding candidates that have experience with the rural medical practices that hospitals like these specialize in.

"It’s very unique when you have to have someone who can do inpatient, cover the emergency department, be able to see clinic patients, and take call – that is a big ask for providers, and that’s what makes rural physicians so unique," Wolff said.

To broaden their candidate pool, JCH&L has been tapping into their connections at the University of Nebraska to identify potential future residents, while working with recruiting firm Jackson Physician Group, which specializes in identifying candidates with knowledge of rural health. Wolff herself has a deep personal experience with rural medicine that she's developed over stops at hospitals literally all across the country, and finding a doctor with that specific skillset is essential for an operation like this so they can "hit the ground running" once they get to Fairbury.

"A lot of times those people are the young adults that knew they wanted to go into medicine early, have a love for rural living, and chose that from the beginning. So they tend to be family medicine docs, which is already what we’re looking for – they can do birth to death, and everything in between," she said. "Sometimes it’s just about planting the seed, getting those residents here to do rotations, they get to see what it is in real life. Sometimes, maybe they’ll be the one that comes back and works for us, and that’s the hope: we’re training them to do good anywhere in rural, but you also hope that you’ve made that impression that they want to come back."

The second arm of the recruitment operation aims to fill immediate gaps with short-term solutions, contractors, physicians that can travel to different areas and are will to take on stints of three or six months, depending on the needs of the destination.

With Dr. Shumard, who Wolff called "a legacy" at this clinic, away on leave and Wergin still on staff for the next few months, JCH&L is still capable of covering its current volume of patients, Wolff said. The clinic is capable of running with four full physicians, but until they get back to that point the remaining staff has been working with existing patients to make sure their needs are met because, ultimately, every individual patient gets to decide how they want to proceed, and who they want to transfer their care to.

While the circumstances surrounding this time of transition aren't ideal - for the patients or the staff - it's certainly not an uncommon scenario for a small rural hospital to have to navigate, which is why Wolff remains optimistic that the team at this clinic can pull through.

"Rural hospitals, as wonderful as we are, and the care we provide, sometimes we have just enough to cover the workload, and we always have to walk that tight margin with being able to have a work-life balance, but knowing that unexpected things can happen quickly, and we have to very much be able to adapt and adjust to keep the core of the mission going, which is to provide that care to the community," Wolff said.