Staffing shortages, technology adoption, and workforce engagement are pressing challenges for medical practice leaders nationwide — but they’re magnified in rural communities. In this episode of the MGMA Insights Podcast, host Daniel Williams speaks with Anthony (Tony) Schirer, executive director of Cheyenne OBGYN and long-time MGMA member. Schirer shares his career journey, strategies for recruiting clinicians, and insights on leveraging technology and professional networks to build resilient practices. From navigating the complexities of rural recruitment to embracing AI and mentorship, this conversation offers practical solutions for today’s healthcare leaders.
From Finance to Healthcare Leadership: A Career Built on Adaptability
Tony Schirer’s journey into healthcare leadership didn’t start in a clinic — it began in the finance department of a hospital. “I joined Swedish Medical Center and worked in the finance department… that was really my kickoff into healthcare,” he said. His early responsibilities included bookkeeping for several clinics that relied on the hospital for financial services.
But the landscape shifted dramatically in the early 1990s with the introduction of the Stark Act, which prohibited hospitals from providing certain services to physicians at no cost. “That’s about the time that the hospital said, we can’t provide this service at no cost to the physicians anymore,” Schirer explained. “And so that’s when I started working for physician groups.”
This transition marked the beginning of a career defined by adaptability. Schirer moved from crunching numbers to managing complex operations, eventually leading a growing OBGYN practice in Cheyenne, Wyoming. Today, his role spans everything from strategic planning and compliance to human resources and technology adoption.
Reflecting on those early years, Schirer noted how the experience shaped his approach to leadership: “I thought I was going to get into a nice job because I was a new graduate… and I realized, oh, I didn’t have any experience.” That realization — and the willingness to pivot — became a recurring theme in his career.
Over time, Schirer’s adaptability has been tested by rapid technological change, evolving regulations, and the unique challenges of rural healthcare. “Technology seems to be changing more rapidly than ever,” he said. “We’re just at the tip of the iceberg with AI.”
His ability to embrace change while maintaining operational stability has been key to his success — and a lesson for practice leaders navigating today’s volatile healthcare environment.
Technology and AI: From Spreadsheets to Smart Solutions
Speaking of change: Few things have transformed healthcare operations as dramatically as technology. Schirer has witnessed that evolution firsthand. “Technology seems to be changing more rapidly than ever,” he said. “We’re just at the tip of the iceberg with AI.”
Schirer’s early career was shaped by tools that now feel like relics. “I remember even back when I first started… one of the accountants wanted me to create a spreadsheet in Quattro Pro. And I was so used to using Lotus 1-2-3,” he recalled. Those early days of manual data entry and clunky software gave way to Excel, which became a game-changer for financial modeling and reporting.
The next big leap came with electronic health records (EHRs). “I think that has just made a big change: some who enjoyed it and some who know they just don’t like it at all,” he noted. He noted that while EHRs improved documentation and compliance, they also introduced new challenges — from workflow disruptions to staff resistance.
Now, Schirer sees artificial intelligence as the next frontier. While his practice hasn’t fully implemented AI-driven tools yet, he recognizes their potential to streamline administrative tasks, reduce errors, and improve patient care. “I think it’s coming to where there’s more AI out there… [right now], it’s just the tip of the iceberg,” he emphasized.
For practice leaders, Schirer’s perspective is clear: technology adoption isn’t optional, it’s inevitable. But success depends on more than buying software. It requires training, change management, and a willingness to rethink workflows. “Over the years, it was the different ways that we computed things… and just the software improvements and enhancements,” Schirer said.
The lesson? Embrace innovation, but do it thoughtfully — because the pace of change isn’t slowing down.
Recruiting in Rural Communities: Patience and Creativity Required
Hiring clinicians in Cheyenne is a marathon, not a sprint, Schirer said. He knows this better than most.
“All of the services would quote me that they could hire somebody in six months. I knew that to come to Cheyenne… it took us about 18 months,” he said. That extended timeline reflects the unique challenges of rural recruitment, where the pool of candidates is smaller and the stakes are higher.
The challenge isn’t just finding qualified physicians, Schirer explained. “It [is also] their family… would they be able to find a job? Could they work remotely?” Spousal employment opportunities, school systems, and lifestyle preferences all play a role in whether a candidate says yes.
Schirer emphasized the importance of lifestyle fit for his clinic: “You have to find the person who wants the outdoor life or being in a smaller place, but still relatively close to Denver.” For some, Cheyenne offers a perfect balance — access to hiking, skiing, and wide-open spaces, with urban amenities just a short drive away. For others, the rural pace and Wyoming winters can be a dealbreaker.
Recruitment also requires creativity and persistence. Schirer shared how his team partnered with one of MGMA's partner organizations, Jackson Physician Search, to broaden outreach — but even with professional help, the process was slow. “It just took time, a lot of patience, and going through all of the interviews… finding some people who really just wanted to be here,” he said.
For rural practices, Schirer’s experience underscores a critical truth: recruitment isn’t transactional, it’s relational. It means selling not just the job, but the community, the lifestyle, and the long-term vision of the practice. “You have to find the right fit,” Schirer said. “That’s what makes the difference.”
Staffing Challenges and Remote Work Realities
Recruiting and retaining talent in a rural setting goes far beyond hiring physicians, however. It touches every role in the practice.
Schirer explained the difficulty of finding qualified candidates for front-desk positions: “Whenever I put an ad out for a basic front desk position, I might get 100-plus applications, but there might only be five or six that are actually good enough to interview,” he said.
Clinical roles present even greater hurdles. “We don’t have a program here locally that trains medical assistants… that’s difficult to recruit,” Schirer noted. While ultrasound programs exist at the local community college, many graduates leave the area, compounding the challenge.
To bridge gaps, Schirer has experimented with remote work solutions — with caution. “I had a nurse… whose husband was in the Air Force… they got relocated down to San Antonio, and she was asking if she could continue working for me,” he said. Using VoIP phones and VPN access, Schirer enabled her to triage calls remotely — a solution that worked for several years.
Still, he prefers in-person staff for flexibility and cross-training: “Employees here tend to do a lot of different things… having someone on-site means they can help out between calls.” For Schirer, remote work can be a temporary fix, but the long-term goal remains building a strong, local team that can adapt to multiple roles.
Building Team Culture: Recognition Matters
Retention doesn’t happen by accident; it starts with creating a workplace where people feel valued and connected. For Schirer, that means blending tangible rewards with a sense of community.
“We do have Christmas bonuses… based on seniority,” Schirer shared. “It’s not just pulling numbers out of the air—it’s structured so people know their loyalty matters.”
But recognition goes beyond financial incentives. Schirer’s team leans into traditions that foster camaraderie. “We have potlucks a lot here. Lots of candy and, you know, just food the people,” he said with a laugh. These informal gatherings help break down silos and create opportunities for staff to connect outside of their daily tasks.
One of the most popular traditions is the annual holiday celebration — but with a twist. “We actually do that after the holidays… usually the first weekend after New Year’s, to unwind and regroup for the year to come,” Schirer explained. By hosting the event after the seasonal rush, the team can relax without the stress of year-end deadlines or holiday chaos.
These efforts may seem simple, but they send a powerful message: Employees are more than just their job titles. “It’s about showing them they’re appreciated,” Schirer said.
In a competitive labor market — especially in rural healthcare — culture can be the deciding factor in whether staff stay or leave. For Schirer, investing in team morale isn’t optional; it’s essential for long-term stability.
Cultivating Connections That Matter
For Schirer, MGMA membership has been a cornerstone of his professional growth — with a caveat: only because he learned to actively engage.
“I started my membership in 1997 and was not very active," he admitted. "Probably like a lot of these new people ... who didn’t know [about] all the resources."
Everything changed in 2000 when he attended an OBGYN-focused MGMA conference. “That’s really what I enjoyed — the networking,” he said. From that point forward, Schirer embraced opportunities to serve on committees, join advisory boards, and even help shape conferences.
That experience fueled his passion for mentorship. “One of the things I was really pushing for is the whole mentoring — how we mentor new people,” Schirer explained, recalling his advocacy for structured programs that pair seasoned administrators with newcomers.
Today, MGMA’s mentorship program is self-directed, requiring members to opt in and find their own match. While Schirer appreciates the flexibility, he worries that busy professionals may not take the initiative. “It takes effort… having somebody reach out to new members… just little things like that,” he said.
In an era of remote work and virtual meetings, these connections matter more than ever.
“Technology has changed everything. We don’t bump shoulders like we used to,” Schirer noted. Mentorship can fill that gap, providing not just technical advice but human connection. For Schirer, MGMA membership is a lot more than resources — it’s the relationships. And those relationships, built through mentorship and networking, can transform careers.
Practical Takeaways
- Plan for long recruitment cycles in rural communities — start early and prioritize cultural fit.
- Leverage technology strategically — AI and EHRs can improve efficiency, but require thoughtful implementation.
- Invest in team culture — recognition programs and social events boost morale and retention.
- Explore hybrid work models cautiously — balance flexibility with compliance and operational needs.
- Engage with professional networks — mentorship and peer learning through MGMA can accelerate growth.
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