Sunday, February 22, 2015

Premier Bone and Joint doctors fly to cities across Wyoming offering specialized care

Lights shine down on the Premier Bone and Joint aircraft in the Cowboy Aviation Hangar at Laramie Regional Airport on the morning of Feb. 3 before a PB&J Beechcraft King Air plane departs for Torrington.
 JEREMY MARTIN/Boomerang photographer

Dr. Mark McKenna watches from a cruising altitude of 11,000 feet as dawn breaks over Wyoming’s plains.

The landscape below is flat, brown and vast — cast in long shadows, creased and riven in watercourses flowing off the Laramie Range.

“Once you clear the mountains, it’s definitely a different terrain,” said the Premier Bone and Joint Centers orthopedic surgeon. “You can watch the sun rise over the course of the flight.”

McKenna rides in a Beechcraft King Air C90A. Guided by Pilot Cody Diekroeger, the twin-engine turboprop sails quietly through the air, its nose pointed for Torrington.

Registered Nurse Abra O’Brien sits across from McKenna, and Lisa Sinicki, Premier Bone and Joint travel staff, rides alongside Diekroeger in the cockpit.

The team is preparing for a long day, one which began before their roughly 6:50 a.m. takeoff from Laramie Regional Airport; one which would take them to clinics in both Torrington and Casper, where McKenna would see some 50 patients, as well as perform one bicep surgery in Casper; and one which would have the entire team back in Laramie by about 7 p.m. — more than 12 hours after departure.

Sitting in the plane’s leather chair, O’Brien said she doesn’t mind flying all over the state on a day-to-day basis.

“Traveling breaks up your week a little bit,” she says. “It’s not the same thing every day.”

McKenna and crew are part of one of the most unique orthopedic practices in the country.

Based in Laramie, Premier Bone and Joint flies eight specialized physicians to 11 towns and cities throughout the state. On any given day, as many as four of the practice’s Beechcraft King Airs could be aloft in Wyoming skies, whisking doctors and nurses to satellite clinics in places as far flung as Gillette and Rock Springs, or as small as Wheatland, Torrington and Douglas.

 “There’s not another group like this, that does what these guys do,” Thomas Wolfe, Premier Bone and Joint CEO, said of the practice. “How they work within the entire state — no other state has this. Other groups might have one plane, but not four. This practice is the biggest of its kind.”

Breadth and scale are not the only distinctive features of the practice, which owes its existence to a sort of symbiotic relationship between the physicians and their patients throughout the state.

On the one hand, a city the size of Laramie could never support nine highly specialized doctors, Wolfe said.

To find a group with this degree of fellowship training, one would have to go to a big city, such as Denver or Salt Lake City.

But by expanding care to Wyoming’s near 600,000 residents, the market is large enough to support the specialized group.

On the other hand, the physicians’ willingness to fly all over the state grants patients access to specialized care in their hometowns — orthopedic treatment they wouldn’t otherwise receive without traveling outside of Wyoming.

Origins of the practice

Premier Bone and Joint’s roots date back to 1973, when David A. Kieffer opened his orthopedic practice in Laramie. He was joined in 1976 by Robert Curnow, and the duo renamed the practice Gem City Bone and Joint.

Over the years, the doctors grew their practice, changed the name to Premier Bone and Joint and began offering care in other cities.

In the early years, doctors ran sorties to satellite clinics in a hired limo. In time, however, it became apparent too many hours were wasted commuting doctors to and fro on the roads, and, in the winters, blizzards and ice-sheathed highways made the trips harrowing and unpredictable.

The partners decided they needed a plane, and the Beechcraft King Air proved worthy of the task.

Today, the practice employs four pilots and more than 120 administrative and clerical staff. It operates locally out of a 33,000 square-foot building in east Laramie, owns clinics in Rock Springs and Casper and rents space to treat patients in nine other locations.

The net effect, Diekroeger said, is a practice covering roughly three-fourths of Wyoming’s 97,814 square miles.

The backbone of the operation is the doctors, each of whom is a partner in the practice. Seven are highly specialized orthopedic surgeons, focusing on a range of subspecialties covering the entire body — from the neck, back and spine, to joints, shoulders and knees.

The eighth physician, Michael Kaplan, specializes in non-operative spinal care and interventional spine management — special methods for treating spinal issues without surgery.

 “I challenge you to find another group — in a town of this size — that has this degree of expertise and advanced, fellowship training and diversity,” Kaplan said of the doctors. “The whole reason we survive is because we’re servicing over 500,000 people. We’re functioning like we’re in a specialized, high-population area, like a city that has 1 million people. But it’s because of what the group has designed with the flight-outreach program and the philosophy of all the doctors that we’re able to do this.”


At about 7:25 a.m. Feb. 3, the plane touches down in Torrington, a city of about 6,500.

During the approach, Diekroeger uses his smartphone to remote-start the Premier Bone and Joint vehicle parked at the Torrington Airport — a warming convenience during cold winter months.

Diekroeger drives the team to the clinic, a medical office building. They operate out of three rooms, McKenna consulting with patients, O’Brien and Sinicki checking them in. On this day, a busy one, 30 patients make the roster. Scrolling through the schedule, O’Brien explains the patients come from all over the area: Guernsey, Fort Laramie, Lingle and Lusk as well as Mitchell and Potter, Nebraska.

One of McKenna’s early patients is Jackson Reifschneider, 17, a Torrington High School student who hurt his knee playing football.

McKenna examines the knee, asking Reifshneider questions and prompting him to take his knee through a series of movements.

Then he offers three suggestions: Work with the pain through therapy, get an MRI to determine the extent of the damage or take injections for the pain. The last suggestion, he said, is an option, but not a good one. It might mask the pain, but wouldn’t help the actual problem.

Reifshneider’s father, Patrick, indicates his son might play football again next season.

“I would like to get done whatever needs doing now so he can get healed up before next fall,” he tells McKenna.

McKenna suggests the MRI would likely be the best idea.

“If it was my kid, that’s would I would do,” he says.

The Reifshneiders schedule an MRI for the following week in Torrington.

After the visit, Patrick Reifshneider describes how he found McKenna.

“I called (Premier Bone and Joint) in Laramie and told them where we were, and they said, ‘We’ve got a guy coming out on Thursday,” he says. “‘And I said, ‘Perfect.’ I mean, it really saves us a lot of time. (Jackson) just had to miss a period of class rather than an entire day of school.”

At midday, Diekroeger returns the crew to the plane. They lunch on salads and sandwiches en route to Casper.

‘Getting to see my patients’

It’s rare to have a physician as highly specialized as McKenna in a city the size of Torrington. Typically, smaller locales are served by generalists — physicians who work on a variety of different ailments.

But Kaplan said Premier Bone and Joint doctors all share a common desire that makes the airborne commutes and small-town clinic visits worth it.

“None of us want to live in downtown Denver or New York City,” he said. “Like anything else, if I could just roll out of bed and get to work within five minutes — that certainly would save time. But, you know, it’s part of who I am, which is, I don’t live in the city as a subspecialist, where I’d drive to work and sit in traffic. I have a different method of getting to see my patients.”

McKenna agreed with Kaplan. After having grown up in Casper, he considers the state, with its vast spaces, his home.

“I was on the wrong side of orthopedics all my childhood,” said McKenna, who played several sports. “I had a lot of injuries. I know it’s cliché, but I like helping people. I like making people feel better.”

Following a successful bicep surgery and some 20 clinical consultations in Casper, the crew returned to the plane at nightfall. Storm clouds gathered as Diekroeger eased the plane into the sky, bearing south for Laramie.

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