Working in the oil fields in the early ’80s when he was just out of high school, Wyoming native Todd H. Beckstead, MD, decided he didn’t want to be a laborer the rest of his life.
When a friend came home from paramedic school and “brought all his toys,” Beckstead says, “I was fascinated, and I was tired of freezing my butt off in the oil fields, so I told my wife we were moving to Salt Lake City so I could go to paramedic school.” Thus began his journey to becoming a general surgeon who specializes in vascular and non-cardiac thoracic surgery.
He worked as a paramedic for eight years, then decided he wanted to go to medical school, and eventually to become a surgeon.
“Working all those years as a paramedic, being in the thick of things—and then I’d worked with my hands all my life doing carpentry and cement work—surgery was a natural choice for me.”
He returned to Wyoming last July after completing his residency at the Phoenix Integrated Surgery Program under H. Harlan Stone, MD. He and a partner now have a growing practice in Casper.
Economic evolution in Casper
Beckstead’s story reflects the cultural and economic shift Casper has undergone in the past two decades, trading its dependence on commodities for services.
Set against the eastern slopes of the foothills of the Rocky Mountains where the North Platte River flows out onto the Great Plains, Casper ushered through pioneers 150 years ago following their yearnings for prosperity and religious freedom. Cattle ranchers settled here, branding Wyoming’s second city with their culture of cowboy life and rodeos. More recent dreamers came this way in search of oil, the gold of the 20th Century.
As Wyoming saddles up for the 21st Century, however, it is pulling away from the well-worn economic trails of oil drilling and agriculture. Even though it has just 479,602 residents, the smallest population of any state in the U.S., Wyoming is blazing a new trail in the service sector for future growth.
“Outlook 2000,” a long-range forecast of Wyoming’s economic and demographic future, was published in February by the state’s Department of Employment, Research and Planning and the Department of Administration and Information. The report shows that what’s been good for the U.S. economy usually has depressed Wyoming’s. This is caused by the state’s economic dependence on mineral and agricultural commodities. “While the national economy suffered through the recession of late 1990 and 1991, Wyoming’s economy remained healthy,” the report says.
“Moving into the mid-part of the 1990s, the national economy recovered, while Wyoming’s rate of growth began to wane at mid-decade under depressed commodity prices.” Even though oil and gas prices are expected to remain strong through 2000, overall employment in the sector is expected to decline through 2008 because of the use of more technology.
The upside is that jobs in the oil fields are being replaced by those in the service-producing economy, including business services, tourism, and health services, which have seen average job growth of three percent since 1990. Through 2008 health services “should maintain a solid growth rate due to the aging population” and an overall increase in the demand for health care in general, according to the report.
With the help of the state, Casper officials have been addressing the jobs issue by attracting new companies. They landed a 65,000-square-foot customer call center for Boise Cascade Office Products Corporation which opened last September. The center will eventually employ 485 people to take customer orders for Boise Cascade’s paper office products. A $1.2 million incentive package, including land and funds for employee training, attracted the company.
Opening in August 2001 will be the $10 million National Historic Trail Interpretive Center to give visitors a view of what it was like to journey West in the late 1800s. The center is a collaboration between the U.S. Bureau of Land Management and a not-for-profit foundation.
An even bigger challenge will be the reclamation of the former Amoco Oil refinery property: 300 acres now surrounded by barbed wire on the north side of the Platte and just a half mile from downtown Casper. Built by the local Midwest Oil Company, which sold to the giant Standard Oil (much later to become Amoco), the refinery operated during most of the 20th Century, closing in 1991. The facility has been torn down, and all that remains is “a classic brownfields project” with hydrocarbon contamination and other hotspots. In the first phase of the reclamation, Amoco is agreeing to clean up the contamination, says Dave Engels, director of the Joint Powers Board representing Casper and Natrona County in the project.
In the reclamation plan is a nine-hole golf course, a business campus, a recreation path to connect with the existing North Platte Parkway, construction of a wetlands with small lakes, and a public building such as a sports facility or performing arts center to be funded with $20 million from Amoco, according to Engels. The redevelopment project should be completed by 2006, but right now Amoco and environmental officials are trying to comply with the 2002 deadline for reaching agreement on all the cleanup remedies, he says.
Once complete, the project will have been worth the wait. “This is an important part of our efforts to revitalize downtown,” says Barbara Ann Winter, the executive director of Casper’s Downtown Development Authority.
“Our downtown has evolved to many one-of-a-kind shops,” Winter says, enumerating a ranch outfitters store that serves afternoon tea in its restaurant, a men’s fine clothing store, bookshops, art supply stores and galleries, custom jewelry shops, a quilting and sewing supplies store, furniture, kitchen supplies, clock repair, soccer wares, and a sporting goods store that also dispenses “good advice on where to go for hunting.”
Several movie theaters bring people downtown in the evenings. During the day, museums, such as the Nicolaysen Art Museum and Discovery Center, appeal to art lovers with changing art exhibits and to children with hands-on science experiences. The Tate Mineralogical Museum houses many specimens of Wyoming’s fascinating geology, as well as some of its dinosaur fossil treasures, including parts of Bertha, a 30- ton, 70-foot long brontosaurus.
Overlooking all this from the south is Casper Mountain, where area residents go for skiing at Hogadon Ski Area in winter and hiking on its many trails in summer. Occasionally the mountain comes to Casper, too. “We hear about a mountain lion coming into town off the mountain from time to time,” says Mark E. Dowell, MD, an internist specializing in infectious diseases. “There are bears around on the back side. It’s great. It’s very beautiful.”
Medicine in rural Wyoming communities
“‘Dr. John Barrasso, helping you care for yourself,’ that’s what I say at the end of each of my reports,” says John A. Barrasso, MD.
His 90-second health-news segments air twice a week on KTWO, Casper’s NBC affiliate, where he reports health news for free as a public service. “It’s what I do instead of golf,” laughs Barrasso, an orthopedic surgeon.
In addition to his volunteer television work, 47-year-old Barrasso serves as medical director of Wyoming Health Fairs, a not-for-profit agency that organizes health fairs annually in each of Wyoming’s 23 counties, bringing the medicine of wellness to rural communities. “They do blood tests for $20 that otherwise would cost $100 if you went someplace and had them all done,” he says.
In a state where managed care has just three percent of the market and where most public health programs are administered independently by county health departments, Barrasso is doing what he thinks works best for Wyoming residents—providing them with information and access.
“This is a place where people do not like big government or big organizations telling them what’s good for them,” he says. For instance, rather than obliging patients to the referral requirements used in managed-care systems, Casper’s medical system depends on the natural factor of distance to perform the gatekeeper function.
“If somebody calls my office, they can get an appointment the next day. They can have immediate access if they are willing to drive in from the ranch to see a doctor,” Barrasso says.
“People in Wyoming are very rugged and individualistic,” he says. “The message that I close with, ‘Helping you care for yourself,’ is meant to be a message of self-empowerment. It’s the message of the whole independent spirit that’s at the heart of this state and why people come out here in the first place.”
History of Casper
Casper, the misspelled city, began in the mid-1800s on the banks of the North Platte River at the convergence of the major westward trails—the Oregon, Mormon, Bridger, California, Bozeman and Pony Express. From the 1840s on, thousands of immigrants followed the trails, and the site of Casper, where many crossed the Platte, was crawling with immigrants for two decades. The Mormon Ferry, fashioned from canoes strapped together and stable enough to get a covered wagon across the stream, crossed the river as early as 1847 and continued until 1859, when a bridge was built. That same year, troops were stationed there to protect the travelers from attacks by Native Americans.
Lt. Caspar W. Collins, just 21 years old, was assigned from Colorado in 1865 to help defend the bridge post. He had been there only a day when, on his way to help a sergeant who had been ambushed, he met his own death charging Cheyennes and Sioux.
The following autumn, the army post at the Platte River was named Fort Caspar in honor of the young lieutenant. The name Fort Collins had already been given to the fort (now a city) in Colorado in honor of Caspar’s father. Fort Caspar remains as a historical site with a museum open year round and five reconstructed fort buildings with historical re-enactments open May through September.
Casper, the city, was incorporated in 1889, just 13 years after Texas Judge Joseph M. Carey trailed 12,000 head of cattle up from Austin to start a ranch in Wyoming. Carey built the first ranch house in the area in 1876, and went on to become a U.S. senator and governor of Wyoming. The divergent, but now official, spelling of the city’s name is attributed to an unknown mail clerk who miswrote the name on all the mail.
Because Casper did not lie on the train route that brought life to many other Wyoming towns, its growth depended on travelers on the Oregon Trail and then on refining oil from the vast Salt Creek field 40 miles north, where the black gold first gushed in 1890. The oil helped fuel World War I and tremendous growth in Casper, including a $1 million high school and luxurious hotels and office buildings. But in the Depression the oil demand vanished—and so did half Casper’s population of 30,000.
The Salt Creek field, known for its rich oil deposits, became more famous during President Harding’s administration when Secretary of the Interior Albert B. Fall secretly granted exclusive drilling rights to his personal friend, Harry Sinclair. The lease eventually was invalidated by the U.S. Supreme Court, and the Teapot Dome Scandal of the 1920s, named after a natural rock formation in the midst of the oil field, resulted in Fall being imprisoned one year and fined $100,000. Sinclair was imprisoned three months and fined $500.
Casper healthcare community
These days Casper’s medical community is working to become a health-care referral center for the entire state.
“I have one partner who does the same things I do, and we are as busy as we can be,” says Beckstead of his surgery practice. “We’re bringing in another partner in July.
“I think we’re so busy because we both do clinics out in the smaller towns. I go to three, and my partner goes to two. And our referral base from other physicians is almost the whole state.”
He appreciates Casper’s fee-for-service environment, in which he’s free to accept as pay from some patients the elk and moose meat they bring him from hunting trips.
Prices are kept reasonable, he says, because the community is small. “You have to be competent, and you can’t be screwing these people because you see them every day.”
Jay A. Swedberg, MD, enjoys the relative freedom from paperwork thanks to the lack of managed care. “I just don’t have to spend the time trying to figure out what plan allows what treatment.
Basically, I make decisions based on what the patients need rather than what some plan allows,” says the family practice physician.
A Colorado native, Swedberg likes the outdoors, and he swears Wyoming’s is better. “When you go someplace out of the way, maybe you’ll see somebody else, but then again, maybe you won’t. You can get out and do things and see the attractions without having to stand in line.”
Swedberg, 52, came to Casper in 1982 and worked 10 years as a faculty member with the University of Wyoming’s Family Practice Residency Program before returning to private practice. “I like teaching, but I like taking care of patients, too,” he says of the switch.
He also serves as the Wyoming delegate to the National Academy of Family Practitioners and is past president of the state medical society. “The state is small enough that there are a lot of opportunities to get involved at the statewide level, where you get to know the governor and the senators, if that’s the thing you want to do,” Swedberg says.
Wyoming Medical Center, Casper’s only hospital and Wyoming’s largest with 282 beds, is doing its part in strengthening the health services sector of the state economy. The not-for-profit hospital is completing a $48 million addition that includes a new Level 2 trauma emergency department, a new outpatient surgical center, new operating rooms, intensive care unit and a new telemetry unit for heart patients.
The hospital has added two neurosurgeons and purchased a Stealth Station Treatment Guidance Platform for precise three-dimensional imaging of a patient’s brain or spine. The hospital also is home to regional cardiovascular and cancer treatment centers.
“Our goal is to be the recognized statewide leader so that patients self-refer here and their physicians are pleased with the care they receive,” says Sharon Miracle, Wyoming Medical Center’s Director of Community Development.
Last year, she says, business grew 20 percent, and the hospital’s aim is to capture a big part of the estimated 15.6 percent of Wyoming patients outside the hospital’s traditional catchment who leave Wyoming for treatment.
The hospital also is heavily involved in providing statewide continuing education for physicians and nurses and sponsoring weekly telemedicine conferences for outlying physicians. It is developing a toll-free information service for physicians looking for input from Casper’s specialists. It also sponsors 13 outreach clinics in the state, in which patients make appointments to see Casper specialists without having to travel to Casper.
In January, the hospital began its statewide, toll-free Ask-A-Nurse health information and physician-referral service. “We believe that if people get information to take better care of themselves, it means that their health condition will be less acute when they get to our facility. Their outcomes are more likely to be positive, and it saves them money,” Miracle says.
Dowell, 42, the only full-time infectious diseases specialist in all Wyoming, has seen his patient load grow so much that he’s getting a partner in July. Physicians in small towns often call him for advice in treating unusual presentations, and he is developing relationships with physicians in Idaho and South Dakota.
Dowell has lived in many cities, first as the son of a college professor, then during his medical training at University of Massachusetts, the University of Texas, and Baylor University. He came to Casper more than seven years ago from Houston.
He thoroughly enjoys being able to fly fish within his beeper’s reception range and waking to the sight of elk grazing on his lawn. “I wouldn’t live in a big city ever again,” he says.
He also is optimistic about Casper’s economic development efforts and is confident that patients throughout Wyoming will increasingly look to the city for their health-care needs.
“The opportunity to be a real regional center and a regional doctor is here in Casper,” he says.
Pam Prescott is a Roscoe, Illinois-based freelance writer.