Feature

In this April 2020 issue

FEATURES

Chickens and the eggs (COVER STORY)
Folks have flocked to Cackle Hatchery for birds since 1936
by Kerri Lotven

Conservation in concert
Pigs, crops and wildlife coexist on Brinker Farms, Missouri’s 2019 Leopold Award winner
by Allison Jenkins

Health care in the country
Rural areas look for ways to cure the shortage of doctors, hospitals
by Nancy Jorgensen

2020 insecticide eartag comparisons
Click to view chart as printed via flipbook.
Click to download pdf of chart.

Creating a safer future - Click to view as flipbook
Annual poster contest raises awareness of risks on the farm

‘Bee’ing good stewards and applicators
Use best practices when spreading or spraying this spring
by Adam Jones

Cocklebur can be a pasture peril
Young spring seedlings of this annual weed are especially toxic to livestock
by Dr. Jim White

Everything under the sun
Running on solar power, MFA Exchange in Meta expects bright future ahead
by Allison Jenkins

DEPARTMENTS & OPINION

Country Corner
Will hemp live up to the hype?
by Allison Jenkins

UpFront/blog
Building for beans
Barn bedding benefits Missouri State Fair cattle exhibitors
New leaders elected to MFA board

Markets
Corn:
Acreage expected to return to 2016 levels
Soybeans:
Chinese purchases could influence spring markets
Cattle:
Record exports, strong demand expected
Wheat:
Buyers waiting on new-crop harvest


Recipes
Stalk of the town-Click to view as printed
CLICK TO SEARCH RECIPE DATABASE
 
BUY, sell, trade - Click to view as printed
Marketplace

Viewpoint
Resilience in a harsh environment

by Ernie Verslues



Click to view flip book

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Everything under the sun

Around this time last year, MFA Exchange in Meta, Mo., found a way to breathe new energy into the business.

Two arrays of roof-installed solar panels are providing electricity for the en­tire facility, including Meta’s modern feed mill that turns out more than 10,000 tons each year. The clean, renewable energy generated by the sun-powered system not only represents the cooperative’s commitment to environmental stewardship but also saves substantial amounts in utility costs.

At the end of February, Manager Rick Brune compared the electric bill gen­erated from the system’s first eight months to the same period of the previous year. The difference was impressive—$3,000 in energy costs versus $13,000.

“That’s a $10,000 savings in less than a year,” Brune said. “I’m pretty happy with that. I was a little disappointed it wasn’t more, but we didn’t have much sun this winter. We’re entering into the months where we should break even or make a little money back because our usage is down and production is up.”

Solar power is just the most recent transformation made by the 95-year-old cooperative, a locally owned affiliate of MFA Incorporated. Meta Farmers Exchange was chartered in 1925, just 11 years after its parent company. Local farmers pur­chased the business from MFA in 1982 and a few years later moved the operation from its original facility to the current location on the edge of town. A fertilizer plant already existed on the 10-acre parcel of land, and the cooperative built a feed mill and warehouse in 1987.

“It’s just been one expansion after another since then,” said Brune, who has helped lead the Exchange through 38 years of its evolution—36 of those as manager. “We operated out of the little fertilizer office until 1993, when we added on to the warehouse and moved our offices over there.”

The most significant changes came in 2016 with the construction of a new showroom and enlarged office space followed in 2017 by an extension of the fertilizer plant and the addition of a state-of-the-art bulk feed mill. The improve­ments increased plant food storage by 800 tons along with adding another mixer and dramatically boosted feed produc­tion capacity and speed.

Brune said these advancements were necessary to meet the needs of its growing customer base, made up mostly of beef producers who farm in the rolling terrain of the Osage River hills. The co-op still serves a few dairies and hog operations, along with row-crop producers who farm the river bottoms.

“It’s pretty incredible when you think about where this co-op started and where it’s at today,” Brune said. “This place has always had good, loyal customers and a strong, open-mind­ed board with progressive thinking. We’ve had slow, steady growth through the years, and I think we’re well positioned for the future.”

Feed and fertilizer make up the majority of sales, although the expanded showroom provides walk-in customers a wide selection of farm supplies and rural lifestyle products. Brune said Meta’s members have evolved almost as much as the co-op itself.

“When I started, most of the farmers were full time with no other outside income,” he said. “Today, there’s only about a handful who don’t have some sort of job to supplement the farm. We have a lot of part-time, weekend farmers. About 80% of our revenue goes toward grass fertilizer and feeding beef cattle.”

The ability to reinvent itself has been key to the co-op’s success, said Rodney Luebbering, a dairy and hog producer and one of seven directors who help govern the business. He said customer loyalty helped the co-op survive some tough times in its beginning, but customer service and operational efficiencies are critical to carry the business into the future.

“This co-op was built on the loyalty of generations before us, which gave it the ability to expand during the good times,” Luebbering said. “The board and management have always been forward-thinking and try to do what’s best for the mem­ber. Investing in the new feed mill and putting in solar power are good examples of that mentality.”

The switch to solar power just made sense financially, Brune said, although he admits he was skeptical when first presented with the idea.

“It was about two years ago, in June or July, when I got a call from someone like a telemarketer asking if we’d ever consid­ered solar power,” Brune said. “I listened to what he had to say, and it sounded like a pretty good deal. They came out, looked at our situation and worked up a plan.”

The company, Artisun Solar, worked with the local utility provider, Ameren subsidiary Union Electric, and installed an array of solar panels on the feed mill roof and another set on top of the warehouse. The total cost was around $168,000, but rebates, tax credits and deductions lowered the out-of-pocket costs to about $60,000, Brune said.

The system operates on a two-way meter, he explained. When more power is needed than what the sun can provide, the extra comes off the grid from Union Electric. But when the solar panels pro­duce more power than the facility uses, that excess goes back to Union Electric, which, in turn, credits the co-op’s bill.

“When you put it all together, with our typical usage, the system will pay for itself in four or five years,” he said. “The compa­ny figured it up for us, and over 30 years, it should put $150,000 to $200,000 on our bottom line—just for using sunshine. The numbers really made it a no-brainer.”

A nearly 100-year-old company could easily become stagnant, but that’s not the case with MFA Exchange in Meta, Luebbering said. New ideas, new efficien­cies and new customers keep the co-op progressing.

“The solar panels may be thinking outside the box, but why wouldn’t you do that? It all makes perfect sense when you really take time to look at it,” he said. “The feed mill, too—it was a tough decision to spend that much money, but as soon as we built it, business instantly grew. The next generation of farmers coming up, they’re looking for service and stability, and they can trust that they will find both of those things here.”

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Chickens and the eggs

Beyond Cackle Hatchery’s unassuming storefront in downtown Lebanon, Mo., 1 million eggs rest in incubators at all times and close to 250,000 birds will hatch each week during the spring season.

It’s a lot to manage, said Jeff Smith, who is the third generation to help run the hatchery now owned by his parents, Nancy and Clifton Smith, and founded by his grandparents, Clifford and Lena Smith, in 1936.

“In the ’20s, ’30s and ’40s, almost every town in the United States had a hatchery,” Jeff said. “But in the 1960s, almost 99% of hatcheries closed their doors because they couldn’t make a living anymore.”

Commercialization and refrigeration had become the norm, he continued. Poultry meat and eggs could be bought at the grocery store.

“At that time, my granddad considered folding up, too,” Jeff said. “My mom and dad lived in St. Louis, and he called them up to see if they might want to give it a go at the hatchery.”

Together, the family put together a business plan to keep the hatchery going. They started offering fancier breeds, and Clifton and Nancy worked jobs outside the hatchery. Jeff joined his parents a little over 20 years ago after leaving a long-time career in the insur­ance and finance sectors.

“We’ve been through a lot of ups and downs in the last 84 years, but all busi­nesses go through cycles,” Jeff said.

The family now employs nearly 90 people during the busy season, which is just ramping up. The highest demand is late March through mid- May, though the hatchery fulfills orders for wholesal­ers and retailers from February through September.

Roughly half of the business is direct retail, Jeff said. People can walk into the same, albeit expanded, building Clifford built all those years ago, but the internet fundamentally changed their business. Customers can also order online to have chicks and other poultry species shipped to their door—no mat­ter where they are in the continental United States.

“When someone places an order online, they are prepaying to reserve those eggs,” Jeff said. “From there, we’ll look at the order and send them the date we anticipate the birds to hatch.”

Though it sounds simple enough, a hatch date may take much cal­culation. Chickens hatch after 21 days, Jeff explained, but ducks hatch in 28 days. Often customers want a variety of birds or breeds, posing the unique challenge of trying to synchronize the hatch date. Once a date is set, the customer receives an email notification and information on how to prepare and care for their new arrivals.

“We have videos and frequently asked questions to help our cus­tomers,” Jeff said. “We want to make sure they have a good experi­ence. It’s in everyone’s benefit to really understand what needs to be done when these babies arrive.”

Every Thursday, 300,000 eggs are delivered to the hatchery from suppliers. Once the birds hatch, they are shipped the same day and delivered to customers within two days.

“The post office is our main distribution system,” Jeff said. “Our hatch days are on Mondays and Wednesdays. When the chicks hatch, they have enough yolk in their systems to survive for a couple of days, but we package them with some bedding, food, and solid H2O, which is an almost gelatin-like substance, to keep them healthy along the way. ”

Hatch days are arduous for Jeff and his fellow employees. With roughly 1 million eggs in incubators at any given time, each Monday and Wednesday results in 125,000 birds respectively—all hatching within mere hours of one another.

It’s a 24/7 business.

“We’re delivering babies here,” Jeff said. “Often we’re exhausted, but we can’t just stop and take a day to rest. It’s like a freight train. We have to be there around the clock.”

The Smiths offer 200 varieties of birds hatched from eggs col­lected on nearly 60 contract farms mostly in the Seymour, Mo., area. Spreading out the farms also spreads out risk.

“Before the 1980s, we used to have 80% of our breeds on our own farm,” Jeff said. “I’m sure you’ve heard the saying, ‘Don’t put all your eggs in one basket.’ Spreading out our suppliers helps keep a disaster like a tornado, fire or disease from wiping us out.”

Customers can order as few as three birds of the same kind or as many as 2,000. In the world of small hobby hatcheries, Cackle Hatchery is the largest in Missouri. They have common and more rare breeds of chicks in addition to waterfowl, tur­keys, guineas, peafowl and gamebirds.

“In earlier generations, people would buy chicks in 25, 50, 100 and 150 lots,” Jeff said. “Today’s customer might just want a few of each bird. What separates us in the market is our variety and quality.”

And in this market, demand exists.

“Business is good because people are wanting to get back to basic living,” Jeff said. “There’s kind of a chicken craze going on. It’s popular to have chickens. It’s almost moved into the pet arena.”

On Tuesdays and Thursdays, customers can pick up their or­ders at the Cackle Hatchery store, where supplies such as MFA poultry feed, waterers, heat lamps and other accessories are also stocked. These days are busy, but it’s a different kind of busy. People come in flurries, picking up boxes of chicks, looking at baby ducks and generally milling about the small showroom.

In early March, one of those walk-in customers was Sarah Morgan of Houston, Mo., who recently moved from Alaska to Missouri with her husband, Spencer, and two children, 3-year-old Cora, and 1-year-old River.

“Land prices were better here,” Sarah said. “We’re starting our own little homestead. This year we’re going to have chickens and bees, and next year we hope to have pigs and goats. We’ve always wanted this, and we felt like we were at a point in our lives where we could do it.”

This kind of resurgence in popularity guides the market currently, but markets always change, Jeff said. In the future, he plans to keep expanding varietal selection, where competitors may only offer basic breeds.

“You have to be able to look at business with new perspec­tive,” he said. “Times have changed, and that’s the thing with business—you are either growing or dying. If you’re just staying at the status quo, it’s probably temporary, and you’re heading up or down.”

The business is no doubt a challenging one, but Jeff grew up here. He now has several children of his own who have also grown up around the hatchery. Jeff said he hopes they go to col­lege and set out on their own for a few years as he did to decide if this is what they really want to do.

“I don’t want them to feel as if this is something they have to do or even should do,” Jeff said. “I went away and came back, but it isn’t for everyone. It becomes your life, but to me there are a lot of demanding occupations out there. There’s pride in a family business.”

For more information, contact your local participating MFA Agri Services to inquire about Chick Day deals or visit online at www.cacklehatchery.com.

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Health care in the country

Small-town hospitals save lives. Dustin Cox knows this from personal experience. In Feb­ruary 2019, two of his coworkers at MFA Agri Services in Trenton, Mo., noticed he was having trouble speaking and called 911. As it turned out, Cox was having a stroke.

“If it wasn’t for our local hospital, I’m not sure what the outcome would have been,” said Cox, manager of MFA in Trenton, population 6,000. “You seldom hear good things about rural hospitals, but I received spot-on care. I’m a prime example of how local hospitals are essential.”

For stroke patients, it’s critical to get treatment within an hour. The local ambulance service arrived within five minutes and transferred him to Trenton’s Wright Memorial Hospital, where medical staff members quickly diagnosed and stabilized him. The nearest urban hospital is in Kan­sas City, normally a 90-minute drive from Trenton. Within an hour of Cox’s arrival at Wright Memorial Hospital, he was airlifted to the Marion Bloch Neuroscience Institute in Kansas City for further treatment. Both hospitals are part of the St. Luke’s Hospital system.

Cox was back at work within a week of having the stroke, grateful to MFA employees Justin Anderson and Kevin Kirk, who realized something was wrong and called immediately for emergency help.

“Not everyone would recognize stroke symptoms,” Cox said. “Especially since I’m 45, and I’m not in the typical stroke age range.”

Doctors at the institute discovered a small hole between the upper two chambers of Cox’s heart that allowed a blood clot to travel to his brain and cause the stroke. He recently underwent a successful outpatient surgery to repair this common heart defect.

“I’m glad I’m able to stick around and be with my fam­ily in my home town,” said Cox, who lives on a farm in Trenton with his wife, Mandy, and their three children.

Unfortunately, not all small-town hospitals like Wright Memorial succeed, leaving a gap in health care for many rural residents. Nine rural hospitals in Missouri have closed since 2014 from a total of approximately 120 full-service acute-care hospitals in the state, according to Dave Dillon, vice president of public and media relations for the Missouri Hospital Association. Of Missouri’s 143 licensed hospitals, 69 are in rural counties, leaving 32 rural counties without a hospital.

“It will take a variety of approaches to address the shortage,” Dillon said, “including rethinking how hospi­tals, physicians and other caregivers work together.”

Rural clinics and hospitals face several financial hurdles, Dillon explained. They serve lower income populations, have a higher share of Medicare and Medicaid patients and a lower share of commercial insurance patients. Hospitals are reimbursed less than cost through Medicare and Medicaid and don’t have the volume of commercially insured or self-pay patients to make up the difference. Rural areas also have a higher percentage of seniors, who tend to suffer from chronic health conditions.

I-70 Hospital in Sweet Springs, Mo., is one of the state’s now-abandoned hospitals. After experiencing many of these financial challenges, the facility closed its doors in February 2019, leaving the town of 1,500, located an hour east of Kansas City, without emergency care. Dennis Dohr­man, a farmer and chairman of the Sweet Springs Ambu­lance District Board, has been working to bring it back.

“It usually takes an extra hour to get to an emergency room now,” said Dohrman, a member of MFA Agri Services of Sweet Springs. “We have a lot of senior citizens in the area, and that extra hour can be critical—especially for stroke patients.”

In December 2019, another out-of-state healthcare enterprise purchased I-70 Hospital. Dohrman said that he’s heard the building is slated to become a “medical mall” with offices for doctors, dentists and other such service providers. Without a full-scale, acute-care hospital in Sweet Springs’ future, he and other local residents are working on a solution.

“We hope to set up a hospital tax district that would fund a 24-hour emergency room,” Dohrman said.

Attracting rural caregivers

While many rural communities are finding it difficult to provide adequate health care, Brookfield, Mo., population 4,500, is overcoming the problem, thanks in part to Dr. Kendal Geno.

“I wanted to be a doctor from the age of 4 or 5,” said Geno, whose family moved to Brookfield when he was 7. “I like the small-town atmosphere, and I always wanted to be a primary-care physician.”

Missouri has 114 counties, 101 of which are considered rural. Of those, 99 have been designated as Primary Medi­cal Care Health Professional Shortage Areas by the federal Health Resources and Services Administration. Linn Coun­ty, where Brookfield is located, is one of them.

“Our health facilities are prime examples of the shortage in our state,” said Geno, who works at Applegate Medical Group and is affiliated with the Pershing Health System, a 25-bed critical-access hospital. “I’m the first new doctor they’ve had here in 15 years.”

Analysis by the American Association of Medical Col­leges projected a shortage of up to 49,000 primary care doctors in Missouri by 2030. Rural places have fewer doc­tors than urban areas, and Missouri’s rural/urban divide is more pronounced than the nation as a whole. According to a Missouri Hospital Association study, the state has 56 primary care physicians per 100,000 rural residents, com­pared to 139 per 100,000 urban residents.

“Research shows that a major determinant in the deci­sion to serve a rural area is if you’re originally from a rural area, like me,” Geno said. 

The 33-year-old returned to Brookfield in 2016 after attending Truman State University in Kirksville, Mo., as an undergraduate, earning a degree from the University of Missouri medical school, and completing his residency at MU University Hospital in Columbia—all of which took 12 years.

Three programs helped Geno in his quest to practice in a rural area. MU’s Rural Track Pipeline Program introduc­es prospective medical students to rural health care. As a sophomore at MU, Geno was accepted into the pipeline’s Bryant Scholars Program, which led him to a pre-accepted spot in the School of Medicine. The university recently received a federal grant of $4 million to train more rural doctors through the pipeline. Missouri was one of eight states to receive the grant.

The state-sponsored Primary Care Resource Initiative for Missouri (PRIMO) forgives loans to med students who commit to practice primary care for five years in under­served areas in Missouri. Geno has one year left of his five-year commitment.

The Missouri Area Health Education Center exposes college students to health professions and prepares them to be accepted in health programs and practices.

Students may be attracted to medicine because of its relatively high pay compared to other professions. Physi­cian compensation in the South Central region of the U.S., which includes Missouri, averages $303,000 annually, according to the 2018 Medscape Physician Compensation Report.

However, newly fledged doctors don’t start out on that pay scale. And the cost of education has escalated. Kathleen Quinn, associate dean for rural health at the MU School of Medicine, reported that the combined cost of eight years of undergraduate and med school studies at MU runs about $346,143. You get paid for your residency, but the pay doesn’t compare to what you earn after completing it. According to the American Association of Medical Colleges, 76% of medical school graduates had a median education debt of $190,000 in 2016.

“I was blessed,” Geno admits. “I got a full-ride scholarship for my undergraduate years, and my medical school costs will be forgiven through PRIMO. I will be debt-free. Help is out there, but you have to look for programs and make a commitment to rural areas.”

Doctors who invest in further training for careers such as cardiology or neurology generally earn more than fam­ily doctors.

“But I would be bored as a specialist,” Geno said. “I love the broad scope of primary care. I can do about every­thing, which is useful in a rural area where you don’t find as many specialists.”

Closing the rural/urban divide

The Missouri Hospital Association’s Dillon points out that making health insurance more available and affordable would help attract and retain small-town providers. Rural residents typically earn less and often can’t afford health insurance. Farmers, who work in one of the most danger­ous occupations, can rarely access group health benefits, he added.

“Farmers in particular are far more likely to be underin­sured,” Geno said. “At the same time, they’re the least like­ly to want to drive an hour and a half to see a specialist.”

John Groves, one of Geno’s patients and a member of Brookfield MFA Agri Services, raises corn, soybeans, wheat and cattle while also working full time as a self-employed carpenter. Three years ago, he fell off a grain bin and broke his leg, which Geno successfully treated at the Brookfield clinic while consulting with a specialist.

“Dr. Geno is a wonderful man, and fortunately I have health insurance, but insurance costs keep rising,” Groves said. “I have to pay a $5,000 deductible before insurance covers any medical expenses. The prices farmers get for soybeans and corn are about the same as they were 20 years ago, but health insurance costs have gone up much faster.”

Accessing government-covered health benefits for low-income people is another hurdle for rural Missouri­ans.

“We’re one of 14 states that hasn’t adopted Medicaid ex­pansion,” Dillon explained. “Fewer people here can access health coverage compared to what would be available in an expansion state.”

The 2010 Affordable Care Act offered states addition­al federal Medicaid dollars to cover more low-income Americans. According to healthinsurance.org, 933,441 Missourians were covered by Medicaid as of July 2018, and about 352,000 additional people would be covered today if the state accepted federal expansion dollars. The Kaiser Family Foundation puts that additional number of eligible people at 232,000.

Missouri has found other ways to address rural health­care problems. In 2013, the legislature allowed first re­sponders to provide additional care in rural communities. In 2014, the legislature expanded telehealth technology, which links experts to local providers. In 2018, Missouri Gov. Mike Parson held a rural health summit that led to a “Reimagine Rural Health” agenda. The plan recommends policies that include expanding access to primary care providers as well as nurse practitioners, physician assis­tants and other caregivers.

Still, challenges continue to pile up. Geno reports that the Brookfield hospital is one of many rural hospitals that no longer delivers babies because of a lack of obstetri­cians. Pregnant women must travel to larger hospitals.

“Having an OB specialist can be expensive because patient volume is low compared to more populated areas,” Dillon said. “Also, OB physicians have some of the highest costs for malpractice insurance.”

For Geno, however, the rural lifestyle of Brookfield gives him and his wife, Amy, a good place to raise their six children and allows them to be active in the community. Besides his practice, Geno is health director for the Linn County Health Department, teaches health classes at area schools and acts as physician at local sporting events.

Recently, while watching his son at a wrestling match, the small-town doc treated a student with a broken finger and another with a fractured collar­bone.

On the down side, he said, other doctors often choose not to work in rural places because they may have to give up big-city amenities and access to medical colleagues and specialty resources. Plus, being a primary-care physician in a small town means keeping odd hours and wearing lots of hats.

“I don’t get much down time,” Geno admitted. “And I have treated people in my living room.”

Keeping caregivers local

In 2020, about 128 students will graduate from MU’s medical school, the smallest in Missouri. Other med schools in the state are at Washington University in St. Louis, the University of Missou­ri-Kansas City, St. Louis University and Kansas City University.

MU exports fewer graduates to other states compared to oth­er Missouri medical schools, according to Quinn, who oversees the Rural Track Pipeline Program.

“Other med schools have more out-of-state students, many of whom end up practicing in other states due to a shortage of Missouri residency positions,” she added.

Katherine Meidl, a fourth-year med student at MU, has been a Pipeline participant since the summer following her sophomore year. This year, Meidl looks forward to returning to her home­town of Hannibal, Mo., population 17,500, to do a medical training rotation at Hannibal Regional Healthcare System, an independent system that serves rural areas. Hannibal Regional Healthcare System and the Hannibal Clinic are training sites for MU’s program.

“When I set my heart on rural medicine, it was through the lens of my parents,” Meidl said, explaining that both her mother and father are physicians at the Hannibal Clinic.

Since this is only the fourth year that Hannibal Regional Healthcare has participated in the pipeline program, there hasn’t been time for the med students to join the system as doc­tors, said Susan Wathen, vice president of human resources.

“The goal is to recruit some of those doctors back here,” she said. “In the future, we will see the fruit of our effort.”

In 2019, the Pipeline led to a summer job for Meidl in a rural clinic in Mound City, Mo., population 1,000, where she created a resource guide. She also created a mental health community guide for St. Joseph.

“There’s a huge need, especially in rural communities, for mental healthcare,” said Meidl, who would eventually like to practice psychiatry through telemedicine connections or by traveling to rural communities.

Like many small-town hospitals, Citizens Memorial Hospi­tal in Bolivar, Mo., had trouble recruiting medical staff. So it developed its own incentives. The hospital’s nonprofit foun­dation raises funds for a Medical Excellence Scholarship that has helped about 500 med and nursing students and others. Today, 50 scholarships are awarded annually. The system also partners with Bolivar Technical College to assist about 30 registered and licensed practical nurses, paramedics and surgical technicians each year and has worked with South­west Baptist University to develop a bachelor’s degree in nursing. Most of this year’s 23 graduates from Southwest Baptist will be local.

“There are a lot of good, rural hospitals,” said Don­ald Babb, who was with Citizens Memorial Hos­pital for 38 years before retiring as CEO Jan. 30. “Unfortunately rural populations are changing as young people move to cities for jobs.”

Under Babb’s leader­ship, the system expanded into eight counties with a second hospital, 35 clinics, seven long-term care facilities and other op­erations, but he admits it takes a lot of hard work to make rural hospitals thrive. In recent decades, several physician-owned clinics around Bolivar found it difficult to survive on their own.

“We’ve worked with physicians who want to partner with us to purchase their clinics,” Babb said.

And while Citizens Memorial may have found the right formula for keeping its facilities staffed, Brookfield’s Dr. Geno encourages more young people to pursue rural medicine to help fill the gaps elsewhere in the state.

“Rural communities need people in the medical profession,” he said. “You can Google clinic jobs almost any­where in the state and find openings that have gone unfilled for years. Oth­er doctors here are nearing retirement, and I can’t do it all.”

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