Alleviating surgical deserts: One way to bring surgeons to rural America

Surgery programs are an integral part of most hospitals, but one type of hospital is struggling to build and maintain them — rural hospitals.

Hundreds of rural counties in the U.S. have no access to a local surgeon, a phenomenon known as "surgical deserts," according to Leon Owens, MD, president and CEO of Surgical Affiliates Management Group. According to a 2009 report from American College of Surgeons Health Policy Research Institute, 30 percent (925) of the 3,107 counties in the U.S. lacked a single surgeon.

This is not only bad for patients who are forced to travel far from home for surgery, but it is also detrimental for these rural hospitals, which miss out on patient volume and a major potential source of revenue in cash-strapped times.

However, a couple obstacles stand in the way of rural hospitals that want to get a surgery program off the ground. Recruiting a surgeon to this type of practice setting can be a tough sell, says Dr. Owens.

"The interest is decreasing for a variety of reasons," Dr. Owens says. "Getting doctors there is difficult." For one, many surgeons prefer working in urban areas, where they'll theoretically have more resources and surgeons to work and discuss cases with. The prospect of being on call 24/7 is unattractive as well, because often surgeons will be a one-man band in these rural areas where low patient volumes don't call for multiple surgeons.

To compound the problem, surgeons are increasingly specializing, leaving fewer general surgeons available to take these jobs.

Surgical hospitalist model

Some rural hospitals have found success with their surgery programs by implementing a unique team approach in a way that is similar to a hospitalist model in primary care.

According to Dr. Owens, the approach involves two surgeons creating one practice, but they alternate one week on and one week off. This helps prevents burnout from having a surgeon be on call every day, and also gives surgeons a colleague with whom to talk through cases.

Sutter Amador Hospital in Jackson, Calif., has found success with this surgical hospitalist model. According to Dr. Owens, bringing in a so-called "surgicalist" team increased case volume and decreased length of stay, since the physicians were using best practices developed at other hospitals, which improved care quality.

There are some hurdles or growing pains associated with such a model, like integrating the surgeons with the existing medical staff. Dr. Owens says this issue can be alleviated through communication and not taking elective surgery cases. "We don't want to be taking their patients from them," he says.

It's also important for all parties involved to remember why a surgicalist team was brought in to the rural hospital in the first place.

"They're able to treat the patients in the community," Dr. Owens says. "That's the driver."

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