Rural Health Issues: Getting It Done Chapter 3

In this chapter, Dr. Charles Rinker makes the point that rural America, in terms of access to surgical care, is at peril of entering the Third World.  Despite being the site where approximately 30% of US patients choose to obtain care, rural health for Americans is a stressed environment:

  • Inhabitants are likely to be poor, poorly educated, aging, and chronically ill
  • The community may be experiencing a declining population and tax base
  • The hospital may be one of the largest employers
  • The survival of the hospital and community are inextricably linked 

Medical schools and residency training programs are turning out specialists who are unwilling and economically unable to practice in small towns due to the physicians’ debt burden. Access to medical and surgical services is an increasing problem for rural communities, because fewer newly minted physicians and surgeons are willing to practice at a distance from large hospitals where they received their training.

The case presentation describes how three rural general surgeons attended seminars in sentinel node biopsy while the hospital’s foundation raised the $15,000 to buy the new equipment.  They were proctored for 14 months until they performed sufficient cases to apply for independent privileges.  Their willingness to embrace new technology gave breast cancer patients the opportunity to receive state-of-the-art care in their home town rather than having to travel several hours to the nearest academic center.

Three steps that rural hospitals can take when facing the loss of a critical community service include:

  • Explain the dilemma to hospital administrators, emphasizing that loss of patients to distant medical centers would have adverse consequences for patients, families, hospital, and surgeons;
  • Develop a plan for acquiring new technology and necessary support personnel. This plan might include involvement of the hospital auxiliary, fund-raising arm, or community service organizations;
  • Explore the possibility of developing a cooperative venture with other community hospitals in the region, in which sharing of equipment, personnel, and patients might occur.

Dr. Rinker wrote that face-to-face conversation between administrators and physicians is the most logical and efficient means of dealing with new threats as they arise:

Although the word “collaborate” may hold unpleasant connotations for some healthcare professionals, it literally means “to work together.” In view of the trends and realities described above, it is in the interest of all parties to find common ground to ensure survival. Unfortunately, distrust and suspicion between physicians and administrators has been the norm over the past few decades, as a result of seemingly divergent agendas. These barriers must be overcome: surgeons must reassess their responsibilities to their hospitals and to the community at large; and administrators must be sensitive to the pressures their doctors face. The two groups must learn how to talk to each other. In our community hospital, we enhanced communication between medical staff and administrators by the establishment of a medical advisory panel, in which we attacked head-on both mutual and conflicting interests of the several parties to resolve differences and find common ground.

What do you think?

  • Does your organization face challenges in keeping up with new technology
  • How do you deal with the constraints you face
  • How have you celebrated and built on success in this evolving area

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2011, all rights reserved

Disclosure: I have not received any compensation for writing this content.

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