The 130th Annual Meeting of APHA

Abstract #39014

Ronald D. Deprez, PhD, MPH, Public Health Research Institute, 120 Exchange Street, Portland, ME 04101, 207-761-7093, rdeprez@phrg.com

Much of the concern regarding access to healthcare services in rural communities has focused on primary care. However, especially considering the high rates of chronic disease found in rural areas, access to specialty physician services is equally important. PHRG, as a strategic planning firm that has worked with rural hospitals and physicians, has found that subspecialty access is an important issue affecting the health status of rural residents and the financial viability of local community hospitals. Provider retention is affected by the interplay of competition- providers locating where there is the greatest demand and synergism- providers locating where there is an already a significant medical community. Thus, the model used to organize specialty services affects not only patient access to healthcare services and the financial success of rural institutions, but also provider satisfaction and retention. After reviewing recent literature, we compared and contrasted benefits and barriers to specialty practice in rural communities elucidated during our work with rural clients, especially our 2001 health planning project with Eastern Maine Medical Center in Bangor, Maine. We discuss the pros and cons of three models of subspecialty practice: 1) Visiting Consulting Clinic Model (VCC), 2) Specialty Satellite Model, and 3) Rural General Internist Model. Our experience leads us to conclude that implementation of any of these three models can positively impact rural access to subspecialty care and hospital financial performance, but that each comes with a unique set of financial implications. While the VCC model generally works well for communities within a relatively close proximity to urban or larger hospitals, it is less effective for more rural, isolated areas because of long travel times and inadequate patient numbers. The Specialty Satellite Model can increase local availability and geographic access to needed specialty services, but requires recruitment efforts and education to the local primary care providers to ensure that specialists will enhance rather than detract from their practices. The Rural General Internist Model, on the other hand, has the potential to enhance the ability of rural primary care physicians to manage more complex medical problems, but unfortunately, does not eliminate the general lack of synergism in many rural areas. In summary, since the predominant VCC model can often be a financial drain on the local hospital and its primary care providers, and can lead to lower care quality locally, the Specialty Satellite model and the Rural General Internist model deserve greater consideration for clinicians and administrators struggling to balance patient access, financial viability, and clinician satisfaction.

Learning Objectives: