Questions are swirling in the Lander community about the hospital’s plans for 2027.
Lander pediatrician Dr. Ryan Firth says SageWest is leaning into travel doctors, called locum tenens, starting in 2027, but the hospital says its new partnership with an unnamed organization is not a locum tenens staffing program.
“SageWest Health Care is strengthening its hospitalist program through a strategic partnership with an experienced organization that specializes in supporting hospital-based physicians and strengthening hospitalist programs,” SageWest told Cowboy State Daily in a prepared statement. “The partnership is not a locum tenens staffing program.”
Hospitalists are doctors who care for patients admitted to the hospital. Many are trained in internal medicine.
SageWest said its new partnership would strengthen its ability to treat patients with more complex medical needs and keep more patients close to home when clinically appropriate.
“It will provide our hospitalists with enhanced clinical leadership, peer support, and access to a broader network of physician expertise,” the statement said.
The hospital’s existing hospitalists have been “encouraged” to explore “opportunities with our new partner.”
SageWest declined requests for an interview and did not respond to follow-up questions, including who the partner is, whether existing hospitalists would be transitioned out of the hospital, or what exploring “opportunities” with the new partner would look like.
Firth told Cowboy State Daily he has spoken with some of the hospitalists and what he’s heard sounds like locum tenens.
“I have heard that they are avoiding using that word or phrase,” Firth added.
What was described to him involves new doctors staffing the hospital on a regular rotating basis.
“These physicians don’t live here, and just come in for their assignment then go home,” Firth said. “To me, that’s clearly a locums doc, regardless of how you label the partnership with the overseeing organization.”
'Version Of Substitute Teaching'
Firth posted his concerns about SageWest’s plans in a video early Thursday. He urged the community to become more informed about the changes ahead for 2027 at SageWest.
“Our local hospital has decided to replace our local hospitalist group with locum physicians in the new year,” he said in the video. “What locum means, it’s basically the doctor version of substitute teaching.”
Firth, a board-certified pediatrician with roughly 17 years of practice in the community, said he has nothing against travel doctors per se. He’s not only worked with them, he’s been one himself.
“Locums have kind of always been part of medical care,” he told Cowboy State Daily. ”A lot of times they serve a really good purpose.”
In the past 10 years, though, Firth has seen the use of locums gradually increase until it’s almost to the point where they’ve become the rule for a wide variety of positions.
“I do think that displacing an established physician group in favor of locums doesn’t make sense,” Firth said. “That doesn’t seem like it’s the best care for the community.”
Until now, SageWest had maintained a locally based hospitalist group to care for adults, Firth added.
“But now it sounds like even that is shifting,” he said.
Concerns About Care After Discharge
Firth said he believes the shift presents challenges for continuity of care, particularly when patients leave the hospital and return to their community doctors.
Passing care from one physician to another is already a routine part of hospital medicine, he said. His bigger concern is whether incoming doctors who only spend a week or two at a location will know what resources are available to help patients recover at home.
“I think what is at risk for being lost, though, with having a lot of outside providers coming in, is they don’t know about the resources for patients once they go home,” he said. “And, in the current health-care system, we’re getting more and more kind of essentially graded on our health care. Insurance companies, Medicare, Medicaid, are really paying attention to things like hospital admission rates.”
Insurers not only track how long patients remain hospitalized but whether they have to be readmitted, Firth added.
“If we get a patient from the hospital and we’re supposed to now pick up their care and take care of them and they deteriorate, go back into the hospital, that looks bad on both of us,” he said. “Nobody wins in that scenario, especially the patient who is being pushed back and forth.”
Lengthening Hospital Stays
Firth credits Lander’s active population — including rock climbers, endurance athletes, ranchers, and oil-field workers — with helping support strong physical and occupational therapy services.
“Anything a physical therapist or occupational therapist could want to treat is represented in Lander,” he said. “But if a locums physician comes into our community and doesn’t know those resources are available, he may be keeping patients in the hospital longer than he needs to.”
Firth said he has encountered that disconnect while coordinating care for babies treated outside the community. Specialists sometimes expect to keep a baby hospitalized until oxygen was no longer needed, he said.
After learning that oxygen could be managed at home with follow-up checks in his clinics, some babies were able to return home much sooner.
“I’ve had babies who have been able to come home a full week sooner than they would have,” he said. “So to me, it’s those kind of care issues, and kind of keeping people healthy and out of the hospital once they go home. I wonder about some of those things falling through the cracks.”
A Difficult Transition
Firth also wanted to support colleagues facing a transition that reminded him of his own departure from the hospital’s practice.
“Five years ago, I was in the position where I was sort of phased, sort of pushed, sort of walked out of the hospital,” he said. “All three were kind of happening. That was a rough transition for me.”
It’s still emotional for him, Firth added.
“Leaving the hospital and making the decision to no longer see patients in the hospital was difficult, because I’m in a community that needs that service, that needs people in the hospital,” he said.
But he felt less confident about the care his patients would get at the facility, partly as it moved to more locum tenens physicians and travel nurses, as well as because of other systems issues, so he decided to phase that out of his practice. Telling the parents in his practice that he no longer provides that care has been difficult.
“That was a different administrator. It was a different CEO. It’s important to mention that,” he said. “But I just thought some of the other hospitalists might be feeling the same way I was, and I just wanted them to know that I’ve been through that. That I support them as a physician.”
Renée Jean can be reached at renee@cowboystatedaily.com.
