Integrated health system builds collegial network of rural surgeons
Reasons to consider leaving were call burden (37.5%), relationship with the local hospital (25.0%), and compensation (25.0%).
The survey also looked at potential retention of these general surgeons in the coming 5 years: 37.5% said they were somewhat likely to remain, 25% said they were very likely to remain, and 37.5% said they were extremely likely to stay.
Two successful strategies have been promoting a satisfactory case mix and comanagement of patients who are referred to the main campus. The surgeons from the small towns are encouraged to come to La Crosse to assist in procedures on referred patients, to teach in the surgical residency and the Transition to Practice General Surgery fellowship programs at Gundersen, to participate in clinical research activities, and to engage in a variety of professional activities that strengthen the bonds between GHS and rural surgeons. These interactions help minimize professional isolation, a serious problem for surgeons working on their own in small communities.
Communication is maintained electronically. “Our system includes the use of a common EMR across the entire system allowing mutual access to both inpatient and outpatient records, including full access to digitized diagnostic imaging. GHS has established a number of distance-learning telemedicine links between the main campus and the rural communities that permit real-time patient consultations as well as participation in teaching conferences including Morbidity and Mortality Conferences.”
Reducing burnout in rural surgeons
The GHS model may have some impact on burnout among the rural surgeons in the system, said Dr. Cogbill. “Rural surgeon employment as part of a fully integrated regional network has the potential to reduce the magnitude of burnout by providing administrative assistance to help navigate bureaucratic complexities, easy access for subspecialty consults with colleagues who are known entities, and a model of rural surgery involving pods of three colleagues who can share call, mutual assistance, and case volumes.” Fair and competitive compensation and some degree of loan forgiveness have been in the mix of factors that have helped with recruitment. Administrative assistance from the main campus eases the clerical burden the surgeons face. Guaranteed free time for vacations and educational meetings, as well as a reasonable call schedule, are all built into contracts; this has had a big impact on recruitment. GHS has concluded that three general surgeons in a community is the optimal number to maintain call coverage and mutual assistance. Dr. Cogbill said, “The call schedule is managed by each “pod” of rural general surgeons themselves. With a full complement of three rural surgeons in a pod, they maintain an every third night call schedule. In towns in which there are fewer than three surgeons, the GHS surgeons often share call with surgeons who are not part of GHS to maintain a reasonable/sustainable call schedule.”
The retention track record at GHS is impressive. Since 1978, 19 rural general surgeons have been employed by GHS. Four (21%) rural general surgeons have retired 10 (53%) continue to practice in the network; only 5 (26%) left prior to retirement. Six rural general surgeons practiced in one location for over 20 years.
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