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October 14, 2011

Community profile: Wausau, WI

WHEN THE FIRST WHITE SETTLERS CAME to Wausau in 1839, they looked with delight upon the towering pine forests that covered the region. North central Wisconsin was indeed the land of opportunity for anyone able to cut down a tree.

A century and a half later, the virgin forests are but a paragraph in the history of Wausau’s development. Managed forests now furnish the resources for the region’s varied wood-products industries, refuge for wildlife, and recreational opportunities for outdoor lovers.

Once a land of lumber camps and sawmill towns, the Wausau area has evolved into a broad-based economy that holds the promise of steady growth. An excellent education system supplies a well-trained work force and opportunities for continuing education in most professions, and the robust Wisconsin climate ensures four distinct seasons for enjoying the natural beauty of the region’s waterways and woodlands.

Medicine in transition

The medical community also is a hallmark of Wausau’s appeal. Excellent facilities, a good mix of primary-care and sub-specialty physicians, and a collegiality between practicing groups have provided quality, economical medical care. But like the Northwoods forests, northern Wisconsin physicians are coming under managers’ hands. Business mergers, buy-outs, and alliances are all part of Wausau’s medical landscape as physicians anticipate a growing demand for ever-more-cost-efficient health care in the 21st century.

"Wausau is an emerging managedcare market," says Charles L. Shabino, MD, a pediatric intensivist who has put away his stethoscope to serve as president and chief medical officer of Wausau Regional Healthcare, Inc., and also chief medical officer for its parent company Community Health Care, Inc.

"What you’re seeing here is consolidation in the medical community. What’s driving it is a concern on the doctors’ part to have a voice in how medical care will be delivered in the future," says Shabino. Unlike other areas of the United States where managed care is firmly in place, often with nonmedical administrators calling the shots, Shabino says in Wausau the groundwork is being laid by doctors. "There’s much stronger physician participation here than in other parts of the country.

"What’s happening in Wausau is the development of at least two strong delivery systems," Shabino says. "You have Marshfield Clinic coming in, which is based on a multi-site delivery system, and you have Community Health Care."

Until recently, Wausau was a community of independent single-specialty and multi-specialty physician groups with Wausau Hospital as their common tertiary care facility. At the beginning of the decade, the hospital created a number of subsidiaries to provide what Shabino calls "a full continuum of care," under the parent company banner Community Health Care, Inc.

Community Health Care’s clinic subsidiary, Wausau Regional Healthcare, made its first two clinic group acquisitions in 1991 and has since added 10 more. It now has a total of 50 physicians working in 18 clinics and medical practices in north central Wisconsin and Michigan’s Upper Peninsula.

Wausau Regional Healthcare has focused on the delivery of primary care and that will continue, Shabino says. "Based on the premise that, in the future of medicine, the focal point of care will be the patient’s encounter with the primary-care physician, this should be a primary-care physician organization, as opposed to one providing multi-specialty services."

That doesn’t eliminate the need for specialists in Wausau, Shabino says. "Wausau Regional has all kinds of relationships with specialists in the community. It’s not a question of being able to provide specialists for patients, but rather than include them in the organization, we’ve chosen to encourage strong provider networks."

A new player

In January, it was announced that Marshfield Clinic would buy Wausau Medical Center, the largest independent, multi-specialty group in the Wausau area. Marshfield Clinic, based 45 miles southwest of Wausau in Marshfield, Wisconsin, has 450 physicians working in 30 locations in central, northern, and western Wisconsin.

With the purchase of Wausau Medical Center, Marshfield Clinic will be able to provide physicians locally to the 18,000 to 20,000 patients it already has in the Wausau area but who, until now, have had to travel 45 miles to see their doctor, says John Smylie, the director of regional operations for Marshfield Clinic.

Ellen Schumann, MD, the president of Wausau Medical Center, says the merger with Marshfield Clinic is being made at a time when local businesses are asking for more choices in health-care plans. "Businesses have said to us that they want competition because they need help in cutting their health-care costs," Schumann says.

With the resources of Marshfield Clinic, she believes Wausau Medical Center can be "in the forefront speaking up for patients in putting together insurance plans for businesses." In addition, the medical center is looking forward to assistance from Marshfield in upgrading its electronic medical record-keeping system and providing additional resources for building projects. Federal Trade Commission approval of the merger is expected in April, at which time, Schumann says, "we will have two very good health-care systems here in Wausau."

Not everyone is sanguine about the merger. Leonard H. Wurman, MD, an otolaryngologist in Wausau, is concerned that Marshfield Clinic’s presence will draw referrals away from Wausau’s specialists. In a guest editorial he wrote for Wausau Daily Herald newspaper in January, Wurman says, "It would seem to me to be a sea change in philosophy by Marshfield, now owning the Wausau Medical Center, to encourage the medical center physicians to refer patients to Wausau’s independent specialists rather than to their own specialists in Marshfield." Despite those concerns, there are others who believe the sort of change coming was inevitable and, ultimately, survivable.

Kevin T. Flaherty, MD, an ophthalmologist who works with seven others at the Eye Clinic of Wisconsin in Wausau, says groups like his are very efficient as physicians and as businessmen.

"We have a lot of efficiency in our size," Flaherty says "Because of that efficiency, if we find a new technique, we can discuss it and decide to use it in a very short time. But if we had to put things through a clinic hierarchy, or if we had to deal with other bureaucracies, we’d be a lot less efficient."

Flaherty will not speculate on how the presence of Marshfield Clinic will affect the medical community. While he admits that some physicians feel threatened, he is not among them. "There are a lot of good physicians in Marshfield, and I don’t mind competing with them on a quality basis, because we are really doing state-of-the-art care," Flaherty says.

The human factor

Even with the anxiety over the impending changes in Wausau’s medical community, working physicians are confident they are in a good place to continue their practices.

Schumann, the president of Wausau Medical Center, was drawn to Wausau not just because of the career opportunities. A Madison, Wisconsin, native and a graduate of the University of Wisconsin-Madison Medical School, she says she likes Wausau because she’s not "a real big-city person, but Wausau still offers a wide range of cultural opportunities."

Perhaps Wausau’s most important assets for Schumann are the people. "They have strong family and moral values, which is very important to me. As a result, it’s still safe," she says, "and drugs and alcohol are not a big problem in the schools."

Wausau’s location in north central Wisconsin is quite far from the Midwest’s large cities. The distance has served as a buffer from some of the challenges that confront large communities. Minneapolis is 90 miles west, Milwaukee is 181 miles southeast, and Chicago is 275 miles southeast.

Just as the medical community now is going through sometimes painful permutations, Wausau’s social structure was challenged in the 1970s and 1980s by the arrival of more than 3,000 Hmong refugees, victims of the political fallout after the Vietnam War. This influx had a considerable impact on a community of 37,000 that previously had less than a 1.5 percent minority population. The schools especially were challenged, and busing was considered to fully integrate the Hmong children into the school system and ensure them equal educational opportunities.

Schumann, who came here in 1984, says what Wausau went through is typical of any community that has to deal with the arrival of a large immigrant group. "It causes an impact on the schools, the social services, everything, but I think it’s been a good growing process for the people here."

Schumann, a pediatrician, says she has enjoyed watching her Hmong patients assimilate over the last 12 years. "I’ve seen them come in and not be able to speak [the language], and then gradually they learn English, and they start to dress differently and become a part of the community. It’s been really fun because I’ve gotten to know whole families and now I’m seeing a generation that was born here."

A hill with a view

Like many towns in Wisconsin, Wausau takes its name from the Native Americans who once populated the region. The word "wausau" is thought to mean "the place from which you can see far away," in the Chippewa language. In modern English, it could mean "the place from which you can do many things."

Schumann says she enjoys Wausau’s outdoor activities winter and summer. "There are a lot of outdoor things I like to do, like cross-country skiing, and in the summer, being close to the lakes," says Schumann. "We like canoeing, biking, walking, hiking. It’s a neat area."

Rising up just outside of Wausau is Rib Mountain, one of the highest points in Wisconsin and a very good vantage point for gazing "far away." Not really a mountain but rather a big hill left by a glacier, Rib Mountain is a state park shrouded in hardwood trees that contribute to the brilliant palette of colors that adorns Wausau’s autumn countryside. The park has picnic areas, hiking and walking trails, off-road bicycling, plus miles of groomed trails for snowmobiling, cross-country skiing, and snowshoeing.

On the north face of Rib Mountain is the privately operated Rib Mountain Ski area, which, at 624 feet, claims the highest vertical in all Wisconsin. Snow-making and grooming equipment ensure good ski conditions even when snowfall is less than abundant.

While Rib Mountain has slopes for all downhill skiing abilities, the bunny-hill set is best served at Sylvan Hill within the city of Wausau. The park offers free ski lessons for children under 13, and the chalet houses a warm fireplace, a cafeteria, and a rental and repair shop for both downhill and cross-country skiers.

The great majority of skiers in Wausau are cross-country skiers. They enjoy a total of 36.6 miles of cross-country ski trails in the Wausau area.

Snowmobilers have ample opportunities too, with 640 miles of groomed trails in Marathon County. And Wausau is considered just the "gateway" to Northwoods winter action. Trails in counties north of Wausau have earned the region a reputation for the best snowmobiling in the nation.

Ice fishing is a popular pastime among folks who crave fresh walleye sizzling in the skillet for supper. Some pursue their finned prey from the comfort of ice shacks planted on northern Wisconsin lakes for the winter; others, dressed in coats as big as astronaut suits, hunch over their little holes in the ice with their backs to the piercing winds.

Wausau is also home to the Badger State Winter Games, Wisconsin’s annual winter sports festival held in early February. Winter sport enthusiasts of all ages and abilities compete in downhill and cross-country skiing, ice hockey, curling, ski jumping, snowboarding, snowshoeing, speed skating and figure skating. The games provide the state’s Olympic hopefuls with an opportunity to train and compete, and give recreational athletes an opportunity to test their mettle, too. A parade, torch run, bonfire, and fireworks enliven the event for both spectators and participants.

The change of seasons means a change in recreation in the Northwoods. When spring emerges people put away their skis and snowmobiles and get out their boats, bicycles, and golf clubs.

Duffers will find eight courses in the area, six of them open to the public. Cyclists enjoy scenic rides through the countryside on the area’s roads and designated bike trails. Boaters, water skiers, fishermen, and swimmers enjoy the area’s 30,000 acres of lakes. Campers can find nearby facilities at Rib Mountain State Park, Lake DuBay Shores Campground near Mosinee, and in three Marathon County parks.

Softball and soccer leagues abound, and the city also has a minor league baseball team, the Wausau Woodchucks.

Wausau is one of two cities in the world (the other is Augsburg, Germany) to have a natural world-class whitewater course in the heart of its business district. The Wisconsin River has hosted the National Slalom Kayak Races and World Cup competitions.

The finer things

With all the outdoor recreational opportunities, Wausau residents also manage to find time to support the fine arts in their community. As ranked by the American Council for the Arts, Wausau is number one in the nation in its  percapita support of the arts for cities with populations under 125,000. In the early 1990s, it ranked for five  consecutive years in the top 10 American cities in its per-capita support of the arts, along with such cities as Winston-Salem, North Carolina; Orlando, Florida; Louisville, Kentucky; Charlotte, North Carolina; and Birmingham, Alabama.

At the restored historic Grand Theater in downtown Wausau, the Performing Arts Foundation presents a calendar of first-rate events, including Broadway tours, internationally acclaimed dance troupes, vocalists, jazz musicians, instrumentalists, and chamber and full-scale orchestras. The Foundation is also the umbrella organization for five affiliated arts groups that provide ballet instruction, community theater for children and adults, musical instruction for all ages, and performance opportunities for amateurs in chamber, symphonic, and jazz music groups.

Dairy delights

Not long ago, it was said that Marathon County had more cows than people. While the cows may be outnumbered now, they do their share in helping Marathon County rank second in the nation in milk production and first in cheese production. In fact, Colby cheese bears the name of a small town in Marathon County where the mild-flavored, semi-firm orange cheese was first created. Throughout the county, cheese factories sell their products directly to the consumer. A local favorite is squeakyfresh cheese curds. These are large chunks of orange cheese usually eaten as a snack.

Marathon County also leads the nation in the cultivation of ginseng, accounting for over 90 percent of America’s crop. Most of the herb is exported to Southeast Asia, where the root is used in teas and capsules to treat a variety of medical problems.

Wausau’s largest employer is Wausau Insurance Companies, which provides a variety of business insurances. Its  television advertising has made the town’s name familiar, and its company logo has elevated a local abandoned train station to landmark status.

The company’s founders, who had been involved in logging in the 19th century, were responsible for making Wisconsin the first state in the nation to require businesses to provide workers’ compensation insurance. The day after the legislation was signed on September 1, 1911, Employers Mutuals of Wausau began marketing its workers’ compensation plans, according to Mary Jane Hettinga, the librarian at the Wausau Historical Museum. "This was a group of lumbermen and professionals who wanted to stay in the area after the logging was over," Hettinga says. In addition to advancing the idea of workers’ compensation, their combined resources provided the investment capital for many of Wausau’s flourishing businesses, Hettinga says.

In keeping with Wausau’s heritage as a lumber town, the area now is home to a number of paper, paper product, lumber, and building material manufacturers. Other products made in Wausau include generators, commercial ventilation systems, wastewater treatment systems, and Fiskars scissors.

Contributing to the area’s economic vitality are two higher education institutions. The University of Wisconsin - Marathon County offers the first two years of college study in Wausau, and North Central Technical Institute, part of the state’s technical school system, of fers degrees in technical fields.

An even pace

For Steven Nichols, MD, whose group of family practitioners was bought by Wausau Regional Healthcare last year, Wausau is the ideal place to live and work.

He has a patient load of about 25 per day. "It’s a good pace," he says. In the summer he can take the afternoon off, "get the kids, and go get in the boat at the in-laws’ lake 50 miles up north."

Nichols finds the medical community to be "very complete," and he is familiar with many of the physicians in town. "Most of the people, you know whom you’re referring them to."

He also finds the large number of family practitioners in Wausau bring respect to the primary-care role in the community. "In other places, if you’re in family practice, you’re at the bottom of the totem pole, but here, because there are so many of us, we’re like the bottom of a pyramid holding up the whole thing. People have to listen to you," Nichols says.

Wendy Hanneman, MD, another family physician affiliated Wausau Regional Healthcare, says Wausau has lots of opportunities for new doctors. "It’s amazing," she says. "We can bring in new doctors, and there are still people looking for physicians.

"There are two walk-in clinics in town, and they’re both very busy, and most of those patients are people who don’t have a regular doctor. And when I’m on call, there are always so many people we see who need a physician of record."

When Hanneman was doing her residency in Wausau in the mid-1980s, she didn’t know if she’d settle here. A native of Wisconsin Rapids 46 miles south, Wausau looked a lot like the mill town she grew up in "until I started looking at it in terms of having kids," she says.

"Wausau is the type of community that is smaller in terms of numbers but that offers you the things that you can only get in bigger cities," Hanneman says. "You have the closeness of friends of a small town, but you also have ballet, theater, and all the things that go on at the Performing Arts Center." The university and the technical school bring a diversity and sophistication that was lacking in Wisconsin Rapids, she says.

But when she looks at the friends she’s made in Wausau, she finds the real reason she’s still there. "I realized that a lot of my friends here were people who were born here, grew up here, and have stayed here. A lot of people have consciously chosen to stay here even when they were able to go elsewhere. To me, that said a lot about the kind of place Wausau is."

Pam Prescott is a free-lance writer based in Roscoe, Illinois.

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