Access to surgery in rural areas is becoming more limited as rural surgeons age out faster than they are being replaced, according to Jonathan C. Sprague, president of Rocky Coast Consulting. Sprague, who facilitates a national Rural General Surgery Coalition (RGSC), likens this to a ticking time bomb.
“While not technically primary care, general surgery is a fundamental health service,” Sprague said. “Yet there are very few physicians coming out of surgery residencies who want to go into general surgery—most want to go into specialty surgery. And of those who want to be general surgeons, few are going out to rural areas.” Sprague added, “Not only is access to surgery clinically important, but most small hospitals are dependent on income they receive from general surgery programs.”
Sprague said that even with rural-sensitive initiatives, such as improving residency programs, developing rural rotations, and starting transition-to-practice programs, it’s still not going to be possible to train enough surgeons over the next decade to meet projected needs. Therefore, hospitals must look at restructuring their delivery systems so that multiple hospitals can work together to provide adequate access to general surgery services.
The National Rural Health Association is the host organization for the coalition. Teryl Eisinger represents NOSORH on the RGSC.
RGSC and NRHA are looking for six to 10 hospital systems/clusters around the country to participate in a project that will identify models for regional collaboration and best practices. In addition to on-site discussions, participants will connect with each other periodically during the study via conference calls to discuss strategies that are working or not working. The coalition will then create a composite report—looking at the strengths and weaknesses of the models, which the hospitals can use as a workbook. Each hospital will also get an analysis looking at their issues, with specific recommendations on how to strengthen their programs.
Although hospitals would have to fund their participation in the study, Sprague said that the outcome could reap big savings. “If you could retain your physicians and tame your turnover, improve scheduling and staffing, or work with other hospitals so you don’t need quite so many surgeons, there could be substantial cost savings,” Sprague said. “For example, if five hospitals in a cluster were able to save one general surgeon FTE that could save $400,000 or more per year.”
Sprague suggested that interested NOSORH members review NOSORH’s 2011 study, Summary of Discussions, Recommendations and Tactics Related to Rural General Surgery. RGSC would also welcome an additional representative from a State Office of Rural Health to work with Eisinger to foster communications with SORHs. The workgroup is not highly demanding, Sprague said, because it only involves some exchanges by email and a couple of conference calls a year that will serve as a forum where people come together and exchange ideas.
For more information on the challenges of assuring access to general surgery and RGSC, or to share thoughts on SORH involvement or to volunteer, contact Jonathan Sprague.
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Presentation (Goad, Shea)