Telemedicine Fills Physician Recruitment Gaps at Nantucket Cottage Hospital

Nantucket Cottage Hospital is in somewhat of a unique situation compared to most hospitals in the United States. Located on an island about 30 miles off the coast of Massachusetts, the 19-bed facility is literally cut off from the mainland, save for flights or a ride on a ferry. The location can make it difficult for patients to receive quality specialty care when they need it, and it also makes it hard to find physicians to practice there full-time. "It's been relatively difficult to recruit to the island," explains Margot Hartmann, MD, PhD, CEO of Nantucket Cottage Hospital.

So, about ten years ago, the hospital took a creative step to overcome its physician recruitment issues: It started a dermatology telemedicine program. "It's a great modality for a little hospital like ours, which has challenges delivering care," says Dr. Hartmann. "It's as if telemedicine was made for us."

Through the program, two dermatologists at Massachusetts General Hospital in Boston — Joseph Kvedar, MD, and Peter Schalock, MD — use telemedicine technology to virtually meet with and diagnose about 1,200 patients on the island each year.

Filling a void

Telemedicine allows the patients on the island to access top-notch specialists that would not otherwise have been easily available to them due to the hospital's location. To visit some specialists before the program started, patients would have to travel to mainland-Massachusetts, a time-consuming journey.

Nantucket Cottage Hospital chose to start its telemedicine program with dermatology because it was one of the first specialties payors would reimburse for telemedicine and because there has been a national shortage in the specialty, according to Dr. Hartmann. "For a long time, there has been a shortage of dermatologists," she explains.

The shortage of dermatologists is somewhat caused by excess demand. Skin cancer rates are on the rise across the country; since 2004, the incidence rates of melanoma in white men and women have been increasing about 3 percent each year, according to the American Academy of Dermatology. The rise in skin-related conditions necessitates more visits to dermatologists and an increased demand for the specialty.

The national rise in skin conditions has manifested itself in NCH's patient population. "There are a lot of skin issues…that need to be addressed here," says Dr. Hartmann. "It was our biggest need…we've had a big wait list. It was the need that drove it."

Now, patients can get skin conditions examined without leaving the island, even though the hospital does not have a dermatologist physically available at all times.

Patient response

Patients on Nantucket seem to have embraced getting diagnosed via telemedicine. "I don't think I've ever had someone refuse to come back," says Joanne Bushong, NP, coordinator for specialty physician services at NCH. She says children have enjoyed the virtual visits because they get to see themselves on the television. "They think that's pretty neat."

Even though the dermatology telemedicine program has mostly gotten great patient reviews, Ms. Bushong says the program has not always been well-received. "Some people still insist to be seen live," she explains. The hospital accommodates them by having a dermatologist treat patients at an on-site clinic once every month. One of the telemedicine physicians from Massachusetts General comes to the island once a quarter as well.

Despite some naysayers, the telemedicine program at the hospital has been successful enough to spread into other specialties. "We'd like to expand it every way we could," says Dr. Hartmann.

Nantucket Cottage Hospital has started using the equipment to connect with Massachusetts General for tele-stroke and tele-pediatrics care. There have also been talks of expanding the hospital's telemedicine program into psychiatric and mental health. "In a [television] generation, [it] might seem a little safer [for patients] to share emotional exposure to a clinician on a TV screen," Dr. Hartmann explains. "There's hope for that in the future."

More Articles on Telemedicine:

FCC Announces up to $400M in Funding to Create, Expand Telemedicine Networks
3 Ways Telemedicine Can Help Alleviate the Physician Shortage
Health IT Roundtable: What Are the Biggest Health IT Issues Going Into 2013?

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