What does it take to lead effectively in rural healthcare while driving measurable improvements in patient access and staff engagement? In this episode of the MGMA Insights Podcast, host Daniel Williams sits down with Macy Dotty, Clinic Director of interventional pain neurology, urology, and visiting specialist at Cuyuna Regional Medical Center (CRMC) in Crosby, Minnesota, to chat about it. Macy is one of MGMA’s 2025 Future Five Award honorees, recognized for her innovative leadership and commitment to improving care in a critical access hospital setting.
Their conversation explored Macy’s journey from graduating during the pandemic to becoming a clinic director, her strategies for reducing patient wait times, boosting staff engagement, and leveraging data for continuous improvement.
From Meteorology Dreams to Healthcare Leadership
“Growing up, I would have told you I was going to be a meteorologist,” Macy explained. “That just didn't work out."
While she was trying to decide which career she would go into, Macy discovered a program at her college for healthcare management — something uncommon at most schools. It piqued her interest.
But after graduating in 2020 during the height of the COVID-19 pandemic, she struggled to find a job in the face of a challenging job market. “I did interview after interview trying to find something to go do after graduating — nobody was interested in a new graduate, no experience,” she explained. Eventually, she landed a six-month contract at CRMC, which turned into a full-time role and ultimately a leadership position.
Coming into healthcare during COVID-19 was anything but ordinary. “One of my first things they had me do outside of day-to-day quality work was help guide and work through how we were going to run through vaccines,” Macy recalled. “We actually had a fish house, CRMC fish house, that we turned into part of our drive-through COVID vaccine system.”
Without traditional onboarding, Macy relied on resourcefulness and persistence. “I really had to learn from the get-go how to be resourceful and lean heavily on curiosity. Lots of late nights teaching myself, asking questions, practicing different things until I knew how to use them and could be of assistance.”
Understanding Rural Healthcare Dynamics
CRMC’s role in rural healthcare goes far beyond its size. “The population of Crosby was around 2,300. We're a critical access hospital with 25 licensed beds, but we are also a very large surgery center. Last year we did over 10,000 surgeries here,” Macy said. “We serve communities of around fifty to sixty thousand, many of which are rural. Some areas still don't have Internet.”
This combination of small-town intimacy and high-volume care creates unique challenges for medical practice leaders. Critical access hospitals like CRMC must balance limited resources with the need to provide comprehensive services. Macy emphasized that their reach extends well beyond city limits: “We like to say we're small but mighty. We do things different here. And we provide a unique experience where people will pass larger other healthcare organizations to come here to receive the care.”
One of the most pressing issues is connectivity. “Some areas still don't have Internet,” Macy noted, recalling how this became a major barrier during COVID-19 vaccine rollout. For rural leaders, this means patient engagement strategies must account for technology gaps — whether through phone-based scheduling, community outreach, or creative solutions like CRMC’s fish house vaccine drive-through.
Another layer of complexity is the seasonal migration of patients. “We know who those people are so that we can best care for them and make sure their institution down in Arizona or Florida has what they need,” Macy explained. CRMC proactively tracks snowbirds to ensure care plans are complete before they leave and that partner facilities in other states have the necessary records. This approach reduces gaps in care and prevents unnecessary delays in treatment.
For practice leaders, Macy’s experience underscores the importance of data-driven patient tracking and inter-organizational communication. Whether through shared EHR systems or manual coordination, continuity of care for transient populations is critical to maintaining quality outcomes.
Reducing Wait Times: A Data-Driven Success Story
One of Macy’s most notable achievements was reducing patient wait times in the interventional pain service line from 54 days to just over 10 — a transformation that directly impacted patient satisfaction and outcomes. “I used my data background and pulled everything I could to see what the data was actually saying,” Macy said. “Our third next available appointment time was 54 days, which is a long time when we're serving a blue-collar community.”
For Macy, the first step was validating staff concerns with hard numbers. “Staff can always say we're really busy or patients are really far out, but in rural healthcare, we don't have the reports that just push to you and say, this is what it is,” she explained. By manually extracting and analyzing scheduling data, Macy identified bottlenecks in provider templates and room utilization.
The solution wasn’t adding staff — it was optimizing workflows. Macy and her team met weekly to dissect every step of the patient journey: “We sat down week after week and just picked apart a different piece of the flow, whether it was the room utilization, the provider schedule templates, or other provider workflows,” she said. The team introduced same-day appointment slots for urgent cases, streamlined scheduling templates, and improved communication between schedulers and providers.
The results were dramatic: “At the end of the last fiscal year, I pulled the data again and was shocked to find it go from 54 to 10,” Macy said. “I actually pulled it three times, three different ways — 'am I doing this right?' It was incredible.”
Building Engagement and Trust
Macy’s leadership philosophy centers on trust and empowerment. “Ultimately, people just want to be seen, heard, valued,” she said. “Making sure they understand that I'm here to support their growth and advocate for them is key. If they've got my back and I've got theirs, then we can do whatever we want."
"The world is our oyster,” she grins. Her approach paid off: Macy’s team ranked above the 99th percentile in Press Ganey engagement scores.
“I spent a lot of time with them, getting to know them as a person because every employee has a life outside of here. Creating an environment where staff trust that their leader has their back makes them feel empowered to share ideas.”
Looking Ahead
As a Future Five honoree, Macy is optimistic about healthcare leadership. “The shift towards innovation and collaboration excites me,” she said. “Using data, technology, partnerships, and smarter ways will help shape healthcare. Creativity is what's going to get us through.”
Her advice for emerging leaders? “Stay up to date with your local and state legislation. See what your state is doing that's either helping or hurting your organization. Staying in tune with what drives your organization down the road is really important.”
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