In the event of a traumatic medical emergency, millions of Americans—especially in rural areas, home for more than 14% of Americans –don’t have access to a qualified surgeon. When an accident does occur, they have to travel miles and hours to find the care they need, putting their health at risk. Often ambulances will pass right by a community hospital to get patients to a qualified trauma care facility. It’s a loss for patients, families, hospitals and the community.
Why is there such a shortage of surgeons in rural America? There are many reasons. The American College of Surgeons notes that more than half of surgeons practicing in rural areas are nearing retirement. In addition, substantial numbers of new general surgeons choose to specialize, and because of the small number of patients in rural areas, there is not enough demand to support these specialty practices. Surgeons often choose to work in or near urban areas, where there are a wealth of professional opportunities for them and amenities, schools and resources for their families. Medical students who might consider rural surgery attend university-based surgical residencies in urban environments. Without exposure to and mentorship from rural practitioners, they often choose to stay in urban facilities.
This situation creates many challenges for hospitals and communities. Frequently elective surgeries are scheduled out of the area, while community residents often choose to simply travel to other locales for health care. Even in emergencies, patients are often diverted 50 miles or more to other facilities.
Sutter Amador Hospital, like many others in rural areas, faced the challenges of 1) recruiting top-notch surgeons, 2) serving and retaining patients in its demographic and 3) achieving long-term clinical and efficiency outcomes.
While providing a range of much needed and high-quality health care services to its patients, the hospital sought to find a way to give its patients and community access to high quality, 24/7/365 acute care surgery services. To that end, hospital leaders began an intensive effort to address their need for qualified surgeons.
They had a strong and successful model to follow. In 2007, their affiliate hospital in the Sutter system, Sutter Medical Center, Sacramento (SMCS) launched a surgicalist program with Surgical Affiliates. A five-year study of the program published in the Journal of American College of Surgeons showed it had generated significant improvements, including:
With this example of how the surgicalist program, also referred to as a surgical hospitalist program, had transformed hospital performance and addressed the surgeon shortage, Sutter Amador and Surgical Affiliates made a commitment to replicate this success with 24/7 surgical teams and a collaborative and programmatic approach that would consistently improve both patient outcomes and hospital efficiency metrics.
Three years into the program, Sutter Amador is already seeing significant outcome improvements and results.
The increase in volumes and improved metrics generated a positive ROI for the program. Additional benefits include the ability to ensure 24/7/365 call coverage; a cap on skyrocketing payments to surgeons and locum tenens companies, thus ensuring greater predictability of expenses; and improvements in the overall responsiveness and timeliness of care. All that and patient satisfaction increased as well.
The success Sutter Amador Hospital has achieved is an outstanding example of how to bring quality surgical care to rural areas. It proves that the surgicalist model works in a rural hospital environment by delivering acute care surgery based on evidence-based guidelines. The result of the model is improved quality of care, patient safety and hospital performance.
If you’re interested in learning more, please request our case study entitled “Off the Beaten Track: A Road Map for Expanding Surgical Care at Rural Hospitals” at http://www.samgi.com/news-type/case-studies/.
i Rural Health Info: https://www.ruralhealthinfo.org/states/united-states
ii New England Journal of Medicine, “Physician Shortages in the Specialties Taking a Toll, March 2011 ( http://www.nejmcareercenter.org/article/physician-shortages-in-the-specialties-taking-a-toll/)
iii The Journal of American College of Surgeons, “Sustainability and Success of the Acute Care Surgery Model in the Nontrauma Setting,” July 2014, Volume 219, Issue 1, Pages 90–98
In this, my last blog in a series about the Acute Care Surgery model, let’s review the benefits for general surgeons.
For surgeons who may not want to start a private practice or who may be looking for alternatives to that career path, an acute care surgery service represents a viable choice. It’s certainly challenging and gratifying on a professional level, and as we collaborate as a team, our skills and efficiency just get better and better. We see improved outcomes in our patients and greater satisfaction with patients and families because their care is handled from start to finish by a dedicated team who is there when patients need them.
The quality of life benefits are also very attractive: comparable income to the private practice model with a predictable work pattern, manageable shifts that allow the surgeon to plan his or life and the freedom to know your patients are receiving excellent care, even in your absence, has had appeal to many.
For example, the surgeon who is thinking of retirement may re-consider when he or she can alleviate the stress of a busy private practice and have control over a schedule. The young physician seeking the camaraderie and team-based care of residency can continue to get the support he or she needs.
Keeping these professionals active is very important in dealing with the impact of the current shortage of surgeons. Even mid-career surgeons who want to have more regularity in their schedules for growing families or other pursuits can have both a satisfying career and the quality of life they want. The acute care surgery model offers the attractions of predictable schedules with the challenge of meeting constantly changing patient needs.
Finally, there is the excitement of being part of something new and revolutionary. The acute care surgeon is a pioneer. Every day we are forging a new path—delivering an innovative solution that transforms the lives of our patients and keeps us engaged in our profession. Because we work in teams, there is always back-up and qualified professionals there for any patient need. We’re able to standardize care, which is a major reason why outcomes improve. Patients are delighted to have this attention, communication and security knowing that they are being overseen 24/7.
The unspoken revolution currently taking place in American surgery is addressing the surgical shortfall while offering the promise of improving patient care and safety, and the potential to increase our own satisfaction as dedicated surgeons. The acute care surgery model is defining the next decade in emergency surgery care and we’re here to see it through.
In my last blog, I talked about the Acute Care Surgery space, highlighting where it is headed, specifically as we seek to attract new surgeons to the profession.
But in an era of surgical shortages, where millions of Americans don’t have ready access to a good surgeon, getting new physicians to join the profession is just Step 1. Step 2 is finding ways to encourage existing surgeons to stay in practice, to avoid burnout and the move to other specialties that may offer greater professional rewards and a more manageable quality of life.
Let’s start by looking at how acute care surgeons help hospitals, patients and private practice surgeons improve their practices.
The acute care surgery model offers a solution to ensure 24/7 availability in the hospital, while providing benefits to all surgeons, and most importantly, to the patients. Focusing solely upon emergency surgical care in the hospital, we care for patients who need emergency general surgery. We are available to immediately respond to any emergency surgery need from the ED. And because we are there, a community surgeon doesn’t have to get a call requiring them to come in at 2 a.m. to care for a car crash victim.
We provide all patient care including consults, covering a full service follow-up clinic to manage those patients requiring care post discharge and perform all surgical procedures during our shift.
In some acute care surgery programs, the surgeons (all board-certified in general surgery, with many holding additional certificates, such as surgical critical care) take 24-hour shifts with the next day off. They are available to handle in-house emergencies and guarantee a response to the ED within 30 minutes when needed. In addition to surgeons, a nurse practitioner (NP) and/or physician assistant (PA) is often part of the team, rounding with the surgeons each day, coordinating care for patients and communicating with the family. They are key members of the team and play an important role in patient communication, treatment and ensure effective hand-off of the patient back to his or her primary physician.
We are a true team, experienced in the latest surgical techniques and procedures. One area of focus is the use of guidelines to ensure we provide optimal care before, during and after a surgery.
When an entire surgical team is incentivized to agree and commit to evidence-based practice management guidelines, variations in care are significantly reduced. Standardizing care has repeatedly been proven to improve efficiencies and outcomes, as well as lower costs. For example:
While there are many benefits to an acute care surgery model, as it is still relatively new, there are concerns and important issues to discuss with our colleagues and partners. One of the concerns is the possible erosion of private practices in the community.
However, as numerous published works have shown, this doesn’t have to be the case. In fact, an article in the Journal of the American College of Surgeonsi demonstrated that despite introduction of a busy Acute Care Surgery team, the volume of cases for private practice surgeons remained the same.
In some instances, relief from ED call has allowed some private practice surgeons to increase their surgical volume; as well as enjoy a more stable office and personal life. In short, the presence of an Acute Care Surgery team enables them to perform more elective surgery cases and can help improve their overall quality of life.
My last blog of this series will address additional advantages this model brings to surgeons.
i Journal of the American College of Surgeons. “Acute Care Surgery: Impact on Practice and Economics of Elective Surgeons.” Preston R. Miller, M.D., FACS, et al. April 2002. (http://www.journalacs.org/article/S1072-7515(12)00073-7/abstract)