Nurse practitioner and CEO of Wyoming clinic talks rural care challenges

Sundance, Wyo., is home to 1,032 people and Crook County Medical Services District Sundance Clinic. It's also the hometown of clinic CEO, Micki Lyons, DNP, MSN, who drives 180 miles a day to return to the community she grew up in and care for it. 

The role of CEO is not one she sought out, she told the American Association of Nurse Practitioners in a recent interview. She was appointed to the role in 2020, just one month after receiving her doctorate. 

The board wanted a CEO who understood the challenges of the rural hometown, and Dr. Lyons happened to be the right fit at the right time, she explained. 

Since then, she has navigated several challenges — ones that are all too common in rural care settings — including scrambling to find coverage if short on staff, lacking specialty services and paving the way for efficiency. 

"One thing we do in rural medicine — and that we do well — is that we're creative," Dr. Lyons told AANP. "We don’t have IV teams, we don’t have respiratory therapy and we don’t have specialists right in our back pocket that we can bring in when we have an ER patient or a critical inpatient. I think it's just about being creative, willing to branch out and learn a lot of different skills to be efficient and productive in a rural area."

For the thousand or so individuals in a certain rural area, the clinics and care facilities that are available can be life-saving, she explained. It often leads to the staff who work in these rural settings wearing many hats, including Dr. Lyons herself, who at times also fills in for providers.

"We're trying to be strategic and ask what the vision of the organization looks like, while at the same time dealing with, 'Oh hey, this patient needs a medication refilled and we don't know if it can be refilled.' It's interesting to kind of toggle back and forth between those roles," she said. 

Wyoming also has many individuals on Medicare and noted that telehealth and transportation access for those in need has been a significant challenge for rural care leaders to figure out.

"Large places, small places…in health care they all have their challenges, but one of the things that we find in Wyoming is that it's truly all small communities with very long distances between them," Dr. Lyons told AANP. "We have no specialists, we don’t do surgery, we don't deliver babies. But our patients still need those services, so trying to find access to those services for them without having to send them hundreds of miles away — I think that’s one of the biggest challenges that we have."

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