Practicing Excellence: A small-town, rural doctor embraces technology

"The rural practitioner has to be incredibly confident in his skills and able to address the unpredictable," says Selenke, a family physician. "You have a lot less control over your schedule. Patients often walk in unannounced with a wide variety of ailments."

One man hurt himself while securing a load to his truck and showed up at Selenke's door with the metal hook of a bungee cord still stuck in his eyelid. There was the elderly woman whose car veered off the road near Selenke's practice before a passerby brought her-unresponsive and without a pulse-to his office. In the midst of performing a well-baby exam, Selenke dashed outside, intubated the woman, and performed CPR before an ambulance arrived to stabilize her.

"In primary care and in a small town, if you want to survive, you put on multiple hats," says Selenke, who is known to everyone in town as "Dr. Jim."

Rural patients tend to be older, poorer, less likely to have private insurance, and more likely to suffer serious injury from accidents compared to their urban counterparts, according to the National Rural Health Association. Plus, Medicare reimbursement tends to be lower, and providers are harder to come by, ratcheting up the pressure on those who serve such areas.

For the most part, Selenke's patient population mirrors the trends typical of rural America: About 40 percent of his 4,000 patients are on Medicare. He practices five days a week and manages to see about 35 patients per day.

He keeps up that prodigious pace with help from his electronic health record system, an investment he made five years ago when he first opened his own practice. He also decided then to maximize his efficiency and lower his overhead by teaching himself what he needed to know to maintain his IT systems. Though going high-tech-and mostly going it alone-was a choice few others in his shoes would likely make, it has made all the difference for Selenke.