Who is driving access to care? Some dedicated doctors. New work, recently published in of the Journal of Bone and Joint Surgery looked at the impact of visiting consultant clinics (VCCs) that were staffed by orthopedic surgeons who travel to meet with patients in rural areas.
According to the May 11, 2016 news release, “…only 30% of rural hospitals have a full-time orthopaedic surgeon…. In this study, researchers specifically looked at VCCs in Iowa, an arrangement that involves regular visits by an orthopaedic surgeon to an outreach site, typically a rural hospital located in a community too small to support a full-time specialist. Patients meet with doctors in person, and receive diagnostic services and some outpatient procedures. More complex procedures are usually referred to larger hospitals with the appropriate resources to support major procedures.”
“Data from 2014 were used to estimate average trip length for participating orthopaedic surgeons and patients in all Iowa census tracts. Primary practice locations, visiting consultant clinic locations, and census tracts were classified according to 2010 Rural-Urban Commuting Areas (RUCA) classifications.
In 2014, 4, 596 VCC days were provided in 80 predominately rural sites throughout Iowa. Forty-five percent of all Iowa-based orthopaedic surgeons participated in a VCC, driving a total of 32, 496 miles per month. The number of Iowa counties with an orthopaedic surgeon increased from 35 to 88, out of 99 counties. For rural patients, the average driving distance to the nearest orthopaedic surgeon was reduced more than 50%—from 19.2 miles to 8.4 miles—improving access to orthopaedic surgeons for between 450, 000 and 670, 000 Iowa residents.”
“Orthopaedic surgeons in Iowa have been involved in rural outreach for more than 25 years, ” said lead study author Thomas S. Gruca, Ph.D., a professor in the Tippie College of Business, University of Iowa. “By traveling to 80 different sites every month, these physicians from Iowa and surrounding states reduced patient travel times and improved access to orthopaedic care.”
Dr. Gruca told OTW, “What we found most interesting is that, in Iowa, a state that by most measures has too few orthopedic surgeons, there is such a concerted effort by physicians to reach out to rural areas where there are a lot of patients but few orthopedic surgeons.”
Asked about the barriers to more orthopedic surgeons doing similar work, he commented, “I expect that time is the main barrier. Driving to rural areas to see patients takes away productive time from a physician’s work day (or makes the work day longer). Furthermore, there has to be support at the rural site as well as a physician’s home office to make this type of outreach work for the orthopedic surgeon, patients and their primary care providers.”
