Panel discusses challenges facing rural surgeons

DES MOINES - Recruiting general surgeons to smaller, rural hospitals can be challenging, said David Hoyt, executive director of the American College of Surgeons, in part because the funding system favors larger hospitals, giving them more residency slots.

Hoyt and four others spoke Friday at Mercy Medical Center in Des Moines about challenges facing rural hospitals and surgeons, including recruitment, training and quality of care.

Joining Hoyt on the panel were Dr. Timothy Breon, a general surgeon based in Oskaloosa; Dr. Philip Caropreso, a general surgeon and professor at the University of Iowa; Keith Mueller, chairman of UI's department of health management and policy; and Jennifer Vermeer, Medicaid director of Iowa.

The creation of Iowa's trauma system in 2001 has decreased the gap between what's being taught in educational courses and what is needed in rural communities, the panelists said.

Hoyt said since the system started, there has been a 49 percent decrease in traumatic brain injury and a 20 percent decrease in mortality.

But challenges remain. The Affordable Care Act is changing the way physicians are paid, moving from a fee-for-service model to one that measures quality of care, Mueller said.

But to measure quality, data such as health care-associated infections, readmission rates and surgical complications must be collected and analyzed. This can be difficult for smaller hospitals because technology costs are high and there may not be enough volume, Vermeer said.

'Rural surgeons feel isolated, feel unrecognized and unsupported,” said Caropreso, who has practiced medicine in a rural setting for 38 years in Iowa. 'The rural health care environment does not always lend itself to data analysis.”

Collaboration is key, Mueller said, whether it's through a regional approach, an affiliation with a larger hospital or by bringing in insurance carriers who are likely to benefit from the data collected.

'With small providers, you have to ask how do you reach some kind of scale so this makes sense as investment strategy?” he said.

Breon said he and a second Oskaloosa surgeon partner with surgeons in Pella to provide coverage around the clock. The group also gets together monthly to discuss the communities.

'We work hard to realize the surgical needs of our communities and try to meet the needs to the fullest extent possible,” he said. 'But if you go to similar communities in Iowa, you may not have access to that kind of surgical care.