Center For Orthopedics & Sports Medicine

CAT Scan Fever

A forward-looking Fairmont surgeon transforms his solo practice into a 100-employee entity in just five years.

Photo by Jeff Silker

Five years ago, Dr. Corey Welchlin faced an uncertain future as the only orthopedic surgeon in Fairmont.

He loved orthopedics and wanted to keep practicing in the town where he was born. But he suspected that the Mayo Health System planned to eventually import its own orthopedic specialists after buying the Fairmont Medical Clinic in 1996 and acquiring the Fairmont Community Hospital in 2000.

While weighing this possibility, Welchlin kept busy with more than a full load of patients. “I couldn’t catch up,” he said. Patients sometimes waited six weeks to see him.

Meanwhile, he grew increasingly concerned that Mayo represented more threat than help for his one-man practice. “Even before they acquired the hospital, it became evident to me that I wasn’t in Mayo’s long-range plan. They’d only give me a non-renewable five-year lease on my small office at the clinic,” Welchlin said. “And I knew I couldn’t survive as a small entity.”

He responded by becoming a large entity, with his own staff of specialists, all of whom are board-certified.

Today the one-time solo practitioner has more than 100 employees, including five orthopedic surgeons, two general surgeons, two podiatrists, an internal medicine specialist, a gynecologist, an ear, nose and throat specialist, an osteopath, an optometrist, a chiropractor, three physician assistants, three nurse practitioners and several occupational and physical therapists, medical technicians and nurses.

His group is the largest tenant in a 14,000-square foot professional building that opened in 2000 and occupies nearly all the space in a 24,000 square-foot addition he built two years later. Last year he also acquired a four-passenger plane, cutting travel time to several outreach clinics he operates in southern Minnesota.

Welchlin attributes this phenomenal growth to the manner in which his group offers medical services and the results his specialists produce for patients. “We do quality work and we treat patients with respect,” he said.

The practice is based in Fairmont, but members fan out daily to offices Welchlin maintains in New Ulm, Blue Earth and Wells in southern Minnesota and Armstrong in northern Iowa. He’s even opened an orthopedic clinic in Hilton Head, S.C., where he has a vacation home. He’s hired Dr. Mark Mudano, a native of that region, to staff the clinic, which is operating in rented space while a permanent building is constructed. He’s sent Nick Evangelista, one of the first two physician assistants he hired in Fairmont, to assist Mudano and to serve as site manager.

Although his group has mushroomed in size and scope the past five years, Welchlin says “I have no idea where it’s headed. I believe we can develop specialty groups that provide care in their respective areas of medicine just as we do in orthopedics. There’s no reason we couldn’t have four- or five-person groups of internists, gynecologists or other specialties,” he mused.

Welchlin and his specialists regularly perform surgery in hospitals at Madelia, Jackson, St. James, Blue Earth, Pipestone, New Ulm and Fairmont.

At a time when many rural hospitals fret about declining revenues and struggle to survive, Welchlin’s healthcare providers represent “plus business.” With the arrival of so many specialists, their operating rooms are busy, not silent, idle antiseptic spaces.

Rep. Bob Gunther of Fairmont regards Welchlin as “one of the sparks helping rural hospitals in our area, providing services they wouldn’t have had in many specialties, including orthopedics and podiatry. He certainly is growing in spite of the fact that Mayo is in Fairmont, Mankato and Albert Lea with a big presence. He’s creating healthcare alternatives for area people.”

Welchlin says a “co-dependent” relationship exists between his medical group and these hospitals. “They depend on us and we depend on them,” he said. He believes that before he assembled his orthopedics team, many area residents took their orthopedics problems elsewhere, seeking specialists in the Twin Cities, Rochester, Sioux Falls, S.D., Spirit Lake, Iowa, and other cities. There’s much less of that erosion now. “Once we became established and started marketing, we became an orthopedics ‘destination,’” Welchlin said.

Although Welchlin’s original intent was to build only a strong orthopedics practice, his entourage began to branch into other specialties for a variety of reasons. For example, the second orthopedic surgeon Welchlin hired focuses on spine surgery. That sometimes requires the assistance of a general surgeon if the spinal repair is approached through the abdomen rather than the back. “We couldn’t find a surgeon around here that was interested in helping, so we had to recruit one,” he said.

Before starting the search, Welchlin said he consulted with area hospitals to see if they could use another general surgeon. He summed up their answer in one word: “Absolutely.”

“We recruited a wonderful guy, Dr. Leroy Hodges, about as nice as you can get. He’s a wonderful member of the team,” Welchlin said. When Hodges’ list of patients began to grow, Welchlin then recruited a second general surgeon, Dr. Carole Vincent, who has developed an equally strong patient following. “Less than a year after we hired Hodges, people in area hospitals kept asking for more surgical services. So we found Vincent,” Welchlin said.

It wasn’t long before other non-orthopedic specialists began expressing an interest in joining Welchlin’s group. Some already practiced in area healthcare organizations, but “they wanted to join us because they like the way we do things,” Welchlin said. “We treat patients the way we would want to be treated. We try to be as functional and as courteous as possible. We don’t over-book. We try to get people in on time in a reasonable manner. When we say surgery is going to be at 7:30 a.m., you can count on that,” he said. “We try to make sure the people we hire, whether specialists or support staff, want to do it this way.”

Welchlin lit the fuse for explosive growth in 1998 with a pair of bold moves. First, he partnered with several other individuals to acquire a site and lay plans for a professional building to house two law firms, three dental offices and his orthopedics practice. Then, in the fall of 1998, he hired his first orthopedic surgeon, Dr. Jeff Garske. They shared the 2,200-square foot office suite he still rented in the Mayo-owned clinic because the new professional building was still being designed.

Garske’s appointment calendar soon became full, so in the fall of 1999, Welchlin hired another orthopedic surgeon, Dr. James Schwartz, the spine specialist. With sparse simplicity, Welchlin describes his staffing strategy: “When we’re full, we need to get somebody else.”

In assembling his orthopedic team, Welchlin demonstrated openness to non-traditional living and working arrangements. Garske, for example, had practiced in New Ulm for 15 years but his family wanted to live in South Carolina. So Garske became an airline commuter, spending alternate weeks in Hilton Head and Fairmont. Now that Welchlin has opened a clinic in Hilton Head, Garske also sees patients there.

On the weeks when Garske’s at home in South Carolina, Welchlin has the services of another airline commuter, Dr. Paul Liebert, who travels to Fairmont from his home in Philadelphia, Penn. “We were looking for somebody to work opposite Garske every other week, to mirror him. Our recruiter found Liebert, who was closing his Philadelphia practice because the cost of malpractice insurance had become so prohibitive,” Welchlin said. Although such insurance is expensive in Minnesota, it costs far less than in Philadelphia, where annual premiums range from $150,000 to $200,000

“When you have the threat of malpractice on your mind all the time, you lose your ability to make clear, objective medical decisions for your patients,” Welchlin said. (Liebert was mentioned, although not by name, in a June 9 Time Magazine article on malpractice insurance.)

For more than a year, Welchlin and his growing team co-existed like sardines in his limited office space, waiting for completion of the professional building. “We had six providers rather than just me working in that space.” In addition to Garske and Schwartz, he’d hired two physician assistants, Nick Evangelista (now in Hilton Head) and Chad Helmstetter and a nurse practitioner, Julie Clements.

In February 2000, the group moved into the new building, erected where an out-of-business Pamida discount store had been torn down. The relief was temporary, however. After only six months “we felt the need for more space,” Welchlin said.

By now, Welchlin had added therapy services and equipment, installed an open-sided diagnostic MRI, and opened a free-standing ambulatory surgery center in the building. He also had hired a podiatrist, Dr. Bruce Neumann, from Redwood Falls, and another orthopedic surgeon, Dr. Rich Banks from Maine. “Banks allowed us to provide better coverage and expand to more communities, including Jackson. There continued to be a demand to see us and we’d figured out a way to recruit and develop territory for new doctors at the same time,” Welchlin said.

To resolve the space issue, Welchlin bought adjoining land, put up a two-story medical headquarters linked to the first building. It includes offices and exam rooms for physicians, an eye-care center, and a physical/occupational therapy area.

Delight edges into Welchlin’s voice as he recalls the first time he operated in the new surgery center, which has windows to the outside, a rare feature for an operating room. “That was an unusual and a very wonderful feeling, all at the same time. It felt like everybody was on the same page, with the same plan, the same desire,” he said. “That’s how I thought medicine should be, with everybody wanting the best outcome for each and every patient.”

That day’s euphoria arrived like a smiling, unexpected friend, perhaps because it was so different, so unlike what he’d come to accept, which tended to be always less than he wanted. In the mid-1990s, he’d often found himself “butting heads with the clinic and the hospital” over issues ranging from patient care to diagnostic equipment. “I wanted block scheduling and I wanted to operate after 2 p.m. I also requested that we train an operating room crew that specialized in orthopedics.”

Welchlin admits he “didn’t always handle things the best way. I wouldn’t back down. I got in a huge fight.” As a result, the hospital suspended him for 18 weeks in 1997 and required him to take a three-week anger management course.

Welchlin drove to Rochester every day for the classes, then drove home and saw patients from 6 to 10 p.m. Suspended from operating in the Fairmont hospital, he took his surgical cases to the Blue Earth and Madelia hospitals.

“The whole messy experience significantly changed my attitude. There are only two things you can control: your attitude and your effort. I came back from the suspension trying to be more ‘user friendly.’ I tried to get them to understand why it’s better to blend with my style of practice. I tried that approach for two years. That’s when it became evident they didn’t want me,” Welchlin said.

He said he “learned a lot about myself and people and relationships” in the anger management classes. “The course was very good. I wish everybody could take it.”

And he obviously likes how his practice has developed since 1998. “Maybe it’s wrong, but I feel things are being done right, finally. It wasn’t quite there before. Something just wasn’t clicking. Now, whether I’m in our clinic or surgery or therapy, everybody seems to be on the same page with the same goal. That was very difficult for me to feel until we built and developed our own center,” he said. “What I wanted back then (in 1997) is what we have here.”

Boning Up On Medicine

Corey Welchlin grew up with dairy cows, hayfields and chores. He was born 44 years ago in Fairmont’s old hospital, located across from Lake Sisseton, near the business district. It’s been torn down, replaced by condominiums overlooking the lake. His parents farmed near Granada, then moved to a farm near St. James, where he graduated from high school in 1976.

Life was simpler then, before he became Dr. Corey Welchlin, orthopedic surgeon, a man with more than 100 employees, including a staff of medical specialists based in Fairmont.

He never aspired to such prominence when he opened his practice in Fairmont in 1990. “I thought I’d be in solo practice for my whole career,” he recalled.

He never envisioned heading a variety of medical groups like the Center for Orthopedics and Sports Medicine, the Center for Surgical Specialties or the South Central Surgical Center. He never imagined that someday he’d be dispatching physicians and surgeons to 14 outreach clinics in Southern Minnesota and Northern Iowa.

Still, as it turned out, his life isn’t as complicated as it appears. He has plenty of time for orthopedics, his first love in medicine. “It’s all I do,” he says. That’s because he leaves the nitty-gritty business details to Larry Boller, who serves as executive director for all of Welchlin’s enterprises.

“The visionary part of it, I like,” Welchlin said. “The day-to-day part, I don’t like. That’s Larry’s job. We talk weekly on strategy, or on a daily basis if we need to. Larry and I are on the same page from a direction standpoint. We meet when we need to meet. I spend the rest of my time in surgery.”

Boller, who has a Masters in business administration and management experience with large clinics in Wisconsin and South Dakota, joined Welchlin in 2000. He waves a sheet of paper, filled with fine print on both sides. It’s the day’s schedule of who’s going where.

“Everybody’s based here, but they don’t stay long. On any given day, they’re off to Sleepy Eye or New Ulm or elsewhere,” Boller said. He has help with the logistics of administration from Rick Walters, director of clinical operations.

In 1998, Welchlin decided to expand his practice by hiring more orthopedic surgeons. He now has five, including one in Hilton Head, SC. But he also employs several other specialists, ranging from general surgeons to podiatrists.

He credits “Larry’s leadership” for adding the other specialists and disciplines beyond orthopedics. He also relies on Boller for help in recruiting and training employees “who will treat patients as we would want to be treated.” Toward that end, Boller has three times attended the Disney Institute in Orlando, Fla., delving into Disney’s approach to customer relations and personnel training.

Boller and Welchlin are firm about requiring employee training, including new employee courses every six months. “These are for all employees, including the doctors,” Welchlin emphasized.

“Without Larry, this practice wouldn’t be zip,” Welchlin said. Then there’s a pause and a grin. “So if it goes down the tube, it’s him, not me.”

Although rural areas have aging populations, Welchlin’s orthopedics practice goes beyond the niche of replacing worn-out knees and hips for elderly patients. “We have a wonderful spectrum of all orthopedics…growth problems in youngsters, farm accidents, hand injuries, industrial stuff. We do a lot of sports injuries and we have a very active shoulder practice,” he said. “It’s not all surgical. We do a lot that’s non-operative with therapy or injections. Not every orthopedic injury requires surgery, but it’s nice to be able to see an orthopedic specialist who can tell you if you need surgery or not.”

Welchlin views orthopedics as a fairly simple, clear-cut, open-and-shut branch of medicine. “The beauty of it is that you figure out what’s wrong with a patient, fix it and move on. Most of the time it’s not a life or death situation. It’s a quality of life issue,” he said. “I love the ability to work with somebody who’s incapacitated. Often within weeks, we can have them doing what they couldn’t do before.”

He began thinking about a medical career while in high school. Don Hanson, his biology teacher and track coach, was “very influential. He made me think I could do it. He challenged me.” His family physician in Madelia, Dr. James Eiselt, also provided encouragement.

“Nobody in my family had ever been in medicine, so it was a foreign concept,” Welchlin said. Also foreign was the notion of a metropolitan practice. “I never considered practicing anywhere else. This is home,” he said. “I was born here and I’ll die here. In between, I plan to provide high quality healthcare to patients, close to their homes.”

His parents, Vance and Beverly, still live on their 240-acre farm near St. James. His father, 78, works the land but no longer has cattle. “The day I went to college was the day the dairy cows were sold,” Welchlin said.

He majored in biology and distributive science and minored in chemistry and business at Gustavus Adolphus College in St. Peter. After meeting a number of pre-med students at Gustavus, Welchlin “felt that I could make it through medical school.” He chose Kirksville College of Osteopathic Medicine in Kirksville, Mo., primarily because Eiselt is an osteopathic physician. “It’s a nice blend of hands-on medicine with traditional medicine,” Welchlin said.

After graduating from medical school, Welchlin began an internship at an osteopathic hospital in Flint, Mich., intending to specialize in family practice. “Some of the medical residents there thought I would be a good candidate for orthopedics, so I started learning about it and fell in love with it,” he said.

Following his four-year orthopedics residency in Flint, Welchlin began practicing in Fairmont in July 1990. He likes working where he grew up. “Ninety percent of my patients call me Corey. They don’t call me Dr. Welchlin. I would have it no other way.”

“I feel like I’m contributing, giving something back. We’re offering something to my home area that wouldn’t be here otherwise,” he said.

“It’s nice at the end of the day to see my doctors and my providers talking, enjoying themselves and kibitzing about what’s happened. It’s nice to see the employees, walking out two or three together, enjoying themselves,” Welchlin said. “It’s nice to see patients with smiles on their faces, feeling good about their experiences. They couldn’t have had this kind of specialty care a few years ago because it wasn’t around.”

Nursing Back To Health

The supply of rural healthcare workers should be bolstered once Presentation College gets rolling in Fairmont.

The college, which has its main campus in Aberdeen, S. Dak., will offer courses this fall leading to degrees in nursing and ancillary medical fields. Classes will be held afternoons and evenings in Fairmont High School.

“It’s going to be wonderful,” said Dr. Corey Welchlin, who heads a large medical-surgical group based in Fairmont. “It’s going to create a pool of people trained with skills to provide medical services in Fairmont and around the area. It’s always hard to find skilled people like these in rural areas. Nursing is one of the truly great jobs. You can take it with you anywhere in the world.”

Bob Wallace, president of the Fairmont Area Chamber of Commerce, said the community is a “good fit” for Presentation. “We’re about the only Minnesota city of more than 10,000 that doesn’t have a post-secondary institution.”

Wallace said the Presentation classes represent a “great opportunity for people who want to get into the medical field because they won’t have to leave town to get the training they need.” There’s a “tremendous demand” for healthcare workers in the area, according to Wallace, who added that both the Fairmont Medical Center and Welchlin’s group are growing.

“We have an aging population and our caregivers are aging. We’re short of nurses and technical personnel,” he said.

© 2003 Connect Business Magazine. All Rights Reserved.

Roger Matz

A freelance writer from Mankato. [Editor: Roger Matz passed away in December, 2003.]

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