"The doctor will see you now" could become more like "one-third of a doctor will see you now" under a new recruitment strategy that’s gaining traction for rural hospitals and clinics across America, including Wyoming.
Called fractional medicine, the idea is that hospitals or clinics can hire difficult-to-recruit specialists on a part-time rotational basis. Urologists, for example, who are difficult to recruit even for larger cities, much less regions with less than 100,000 population.
But what if a hospital could fill that position with three urologists who each serve 10 days per month? Then the clinic or hospital could still provide that care right there in its own community, without having to convince someone to move to their community full-time.
That in turn helps patients, who then don’t need to drive to a larger city for the care.
The urologists, meanwhile, get a little more flexibility in their schedules.
They could choose to work just one 10-day stint at a rural hospital or clinic. Or, they could pick up a couple of others in different communities, depending on what works best for them. That also lets them travel and see the country, sampling what other parts of the country might have to offer.
Stopping Brain Drain
Aimed primarily at rural America, the fractional physician approach can also be used to improve the schedule of existing staff, which is how it’s being used by Casper Orthopedics in Wyoming. They’ve hired a company called Synergy Health to schedule three fractional orthopedic surgeons, who each serve 10 days each month, to cover trauma calls for the clinic.
Trauma calls for the clinic have been particularly problematic in the past, driving physician burnout, according to Casper Orthopedics CEO Charlie Robertson.
“In the old model, the way things used to be done back when Casper Orthopedics started, you’d have a full clinic day, say 15 patients in the morning and 15 patients in the afternoon,” he said. “And so, you’d be going along, seeing your patients, and then you get a call that there was a trauma at the hospital.”
The surgeon would have to cancel all his remaining appointments, leaving up to 30 patients to reschedule.
“Not only is that very frustrating to patients, and rightfully so, but the physician gets frustrated or the surgeon,” Robertson said. “Because where is he going to put those on an already busy schedule, when he’s booked out a couple of weeks?”
Robertson said the clinic has tried other approaches too, like maintaining an on-call orthopedic surgeon. But that proved frustrating as well, because there was often nothing for the on-call surgeon to do but hurry up and wait.
Having three fractional surgeons covering trauma calls has made it less of a burden for everyone involved. It’s only 10 days of on-call waiting around for each of the fractional surgeons, while the full-time surgeons appreciate being able to focus on existing, scheduled patients.
Falling Reimbursements Have Hurt Recruitment
Wyoming does have a huge physician shortage overall, Robertson said, and it extends throughout many different specialties.
“My daughter just had a baby — and we live in Casper, the second largest city in the state — and she had to have (the baby) delivered in Douglas, because our OB-GYN care here in Casper is not adequately staffed.”
Part of the problem has to do with medical reimbursements, Robertson said.
“Insurance reimbursement rates, Medicare reimbursement rates continue to fall,” he said. “Medicare, insurance companies want to pay you less and less. All of that is a contributing factor to some of this.”
That means having doctors who must see more patients to get paid — and yet still get paid less overall —which has become a frustration to many in the profession.
“They want to live a good life, put their kids through school, buy a house,” Robertson said.
Physician shortages are being driven in part by financial stress, particularly in rural areas of the nation, according to Synergy Health’s Chief Medical Officer, Dr. Richard Makowiec.
“Wyoming is not alone,” he said. “A lot of rural America is facing healthcare provider shortages, as well as hospital closures. And there’s a number of reasons for it, but at the end of the day, financial stress is the primary driver.”
Rural communities have smaller populations, which means lower occupancy rates.
That leaves their hospitals more vulnerable to economic fluctuation and can make recruitment for existing services more difficult, much less expanding to offer a new service.
Building A Bridge To New Services
New programs are another area where the fractional physician model can be helpful, according Ivinson Memorial Hospital Chief Operations Officer Terry Moss.
When Ivinson wanted to look at starting a new orthopedic program, they turned to Synergy Health to help them explore that idea. Synergy’s help went beyond simply supplying doctors in that case.
“We wanted their expertise, not just providing the physicians, but also how to monitor, look at the data, see the type of visits, see how we were keeping cases in Laramie,” Moss said. “Because that is the biggest thing in our state is, people want to keep those services in their community.”
Hospitals, Moss added, are already under a lot of pressure, because reimbursements are falling all the time — but expenses continue to rise. Rising costs add to the risk of starting new services, but services like Synergy Health’s can help explore an idea before total commitment.
“We wanted to make sure it was viable from a business standpoint,” Moss said. “And (Synergy) helped us understand that. We did that for almost a year, and then we started to transition to our own orthopedic service line after that.”
Better Life Balance Strengthens Recruitment, Retention
Getting doctors to Wyoming, regardless of specialty, is a time-consuming process, Robertson said, and that’s another area where he’s used Synergy Health, to help fill temporary physician gaps.
Robertson estimates recruitment is a minimum 18-month process, on up to two years. During that timeframe, it’s helpful to have fractional physicians who can cover patients, to ensure the recruitment process can be as thorough as it needs to be.
“You don’t just go out and put an ad on Indeed and get an orthopedic surgeon,” Robertson said. “I would be nervous, if you did, about what kind of orthopedic surgeon you’re getting.”
During his recruitment efforts, he’s finding that the improved scheduling Synergy Health makes possible has become something of a recruitment tool.
“When you can tell an incoming orthopedic surgeon that they don’t have to worry about covering call, it’s an advantage for us,” Robertson said. “Covering calls can be very taxing.”
The calls come in at all hours of the night, Robertson said, and they come in regardless of whether the doctor on call needs more sleep than he’s getting. Finding out that won’t be part of their duties makes it a little easier to sell the role in Wyoming.
“Surgeons are just like everybody else,” Robertson said. “They have families, they have wives and husbands, and they have children. Their children are going to school, and their children are struggling with math and fifth grade. They want to dedicate their lives to their families as well, but it’s difficult when they’re getting phone calls and getting pulled out of the house all the time. So, this helps them lead kind of a normal life or getting closer to a normal life.”
Renée Jean can be reached at renee@cowboystatedaily.com.
