Share or Else

Carrie Vaughan, for HealthLeaders Media, May 7, 2008

As a parent, I am constantly telling my children that they need to share a favorite toy; otherwise, neither will get to play with it. Turns out some rural and community hospitals may need to learn that same lesson. Although these organizations are fighting over physicians instead of dolls or stuffed animals, the end result may be the same—either they learn to share or neither may have success filling that vacant position.

It’s no secret that rural areas have a difficult time recruiting specialists and primary-care physicians. Medical schools like Oregon Health Science University are devising strategies to attract more graduates to practice medicine in rural areas. For example, OHSU is working with two Oregon universities that have pre-med programs, hospital associations, the Oregon Medical Association, and the Oregon Board of Medical Examiners on rural residency initiatives, loan forgiveness programs, and priority in scheduling of medical license examinations—all part of an effort to entice more grads to set up shop in rural America. Yet even if those strategies are successful, they still won’t completely alleviate the shortfall of docs. According to some estimates, medical schools just aren’t producing enough physicians to offset the shortage of doctors.

So for smaller hospitals in outlying regions, why not recruit together? Sure, you’ll have to find a physician who doesn’t mind spending three days in one location and two days in another. But aside from filling a vacant position that will benefit everyone—the hospitals, the communities, the doc—the hospitals could also split the income guarantee accordingly. Now the hospitals can treat more patients locally, patients don’t have to travel for services, and the physician can lock up the market. By working in both places, the doctor has a better chance of keeping other physicians from setting up satellite clinics to serve that community. Sounds like a win-win-win arrangement.

But nothing in healthcare is easy. Just as young children (or even not-so-young children) often find sharing a toy difficult, rural communities, medical staff, or even hospitals sometimes need a little convincing. “Sometimes we get so competitive that we forget that I may not be quite big enough for this and you may not be quite big enough for that, so why don’t we recruit together,” says Robin E. Lake, the chief executive officer of the 77-licensed-bed Great Plains Regional Medical Center in Elk City, OK.

Lake already has a great working relationship with two of the critical-access hospital administrators in the region, because they used to work at Great Plains. “We are on a first-name basis with them, so whenever there is a problem they can easily pick up the phone,” he says. That open communication helps the facilities share the limited supply of specialists in the region--Great Plains is the “big dog” with about 38 physicians, including the only full-time cardiologist, orthopedic surgeon, psychiatrist, and two of the three general surgeons, just to name a few.

Beyond the hospitals themselves, often the bigger challenge is convincing the community and medical staff, which can be quite competitive, Lake says. “This is not Friday night football. This is sharing a specialist. Western Oklahoma could support more specialists, and we could keep more patients at home, and make everyone happier if we could just learn to say, ‘OK. Let’s split it.’”

Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at

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