By Dan Surdam, MD & Amy Surdam, FNP

“As healthcare providers, we are working towards solutions every day and trying to contribute to a better way.”


July, 2018

General health


We have health care issues in Wyoming.

Our health care costs are high, we don’t have enough providers, and prevention has taken a back seat.

Health Care Costs Are Rising

In 2017, 11.5% of Wyoming’s citizens did not have health insurance. Compared to the rest of the nation, Wyoming ranks 7th for uninsured. Additionally, according to, “average individual market health insurance premiums in Wyoming are the highest in the country in 2018”.

Lack of Providers

We have a physician shortage in Wyoming. We have a registered nurse shortage, a mental health provider shortage, a certified nursing assistance shortage, etc. Additional training funds, mid-level providers, and telemedicine among other initiatives are helping to combat this shortage, however, there is much more work to be done. According to the Wyoming Medical Society, “the shortage of doctors and medical services, combined with the difficulty in recruiting and retaining new physicians to the state, is taking a higher and higher toll on patients’ ability to find doctors to get the health care they need locally. Patients must wait longer and drive farther to access medical services”.

Prevention Is Neglected

When you are struggling to have basic needs covered, it is no wonder prevention is not a priority. But, in Wyoming, our lack of prevention is unacceptable.

Here’s a look at the numbers:

50th place for adults without appropriate cancer screening

50th place for young children without recommended vaccinations

49th place for adults without a routine doctor visit in the prior two years

47th for adults without a usual source of medical care.


Lack of prevention and a regular medical home creates a reactionary based medical model, one in which when people have an acute illness or injury they don’t know where to go and what to do and thus tend to head to the emergency department which is the most expensive place for care. Additionally, better prevention methods could help prevent illnesses and injuries from occurring in the first place.

When a patient has a high deductible health insurance plan or no health insurance, the patient often compares the cost of an office visit to the risk of not seeking care at all. The concern with this is that the layperson and not a professional is the one calculating that risk. The odds of a miscalculation are high. Many times early prevention and intervention can mitigate worsening disease or injuries that land people in the Emergency Department or admitted to the hospital.

Even if costs were not a factor, the lack of a relationship with a health care provider also contributes to patients having no one to advise or guide them with medical decision making and they may find themselves in the same situation.

Finding Solutions

According to Senator Enzi, “we need to focus on bringing down high costs so that everyone can have access to the care they need. The rising cost of healthcare in Wyoming and across the nation has passed the point of crisis for many, especially small businesses and working families.”

We agree.

Health Care in Wyoming is complex. We expect the solutions will be equally complex and multifactorial. As healthcare providers, we are working towards solutions every day and trying to contribute to a better way.

One solution is by increasing the utilization of telemedicine. At our clinics, we offer telemedicine to anyone in Wyoming. It’s simple, affordable, easy to use, and can be accessed by going to our website and clicking a single button. If a patient has a primary care provider, we will send the notes from your visit to that provider so they can know why the patient was seen and what treatment was received.  We are pleased to say that we are not alone in this effort. Many other healthcare providers in Wyoming offer this type of service and there seems to be increasing efforts by ENDOW and others to advance this platform of accessibility.

Another solution is through membership programs also known as direct care or direct primary care. Memberships are simple, transparent, low-cost monthly programs that allow a patient to visit a clinic as much as they would like to, much like a gym membership. There can be many variations in how memberships work and what type of access to healthcare is received with a membership.

To eliminate the barrier of additional costs that might keep a patient from coming in for prevention or early disease detection, there is never a deductible and many times there is not a co-pay. A patient pays one flat fee per month to obtain unlimited access to his or her health care provider with no surprise costs.

That being said, we do recognize catastrophic events can occur and highly recommend a high deductible health insurance plan in conjunction with a membership to provide maximum protection.

There are several providers who offer this model in Wyoming, including us, and the movement towards this type of service seems to be gaining momentum nationally. At the Federal level, there is legislation moving forward which would allow Health Savings Accounts (HSA) to fund a monthly membership much like a Health Reserve Account (HRA) already does. Additionally, the State of Nebraska is conducting a large, four-year study to demonstrate not only the cost savings aspect of this type of healthcare model but also the improved health outcomes of the patient.

There are many more solutions to Wyoming’s healthcare issues, such as focusing on wellness, healthy living, and collaboration with other providers. We look forward to exploring and implementing many more tactics to help make Wyoming a healthier state with better access to health care at a lower cost.

If you have any ideas or comments, please email us at We’d love to hear from you!