In the May 4, 2016 issue of The Journal, Gruca et al. describe the very effective outreach efforts among Iowan orthopaedic surgeons to rural patients throughout their state. Iowa’s orthopaedic surgeons have demonstrated a high degree of commitment to staffing so-called visiting consultant clinics (VCCs) in rural communities. Forty-five percent of all Iowa-based orthopaedists traveled a cumulative total of 32,496 miles per month during 2014 to staff VCCs.
No matter where they live, patients typically do not like to travel far for medical care. For conditions like cancer or severe cardiac disease, the prospect of travel may be more acceptable, because patients and families feel that the potential for significant illness or death warrants “whatever it takes” to gain access to the highest level of expertise available. But for routine musculoskeletal diagnoses such as osteoarthritis of the knee or rotator cuff tendinosis, the option of gaining access to a high degree of expertise closer to home is very appealing.
I wonder, however, whether the loss of time and expertise entailed with surgeons driving long distances makes sense. My hunch is that in the next few years, web-based telemedicine—which Gruca et al. say was lagging in Iowa at the time of their study—will become the norm for delivering specialty care to rural communities. Also, while it probably doesn’t make sense to outfit and staff small rural critical-access hospitals to do complex orthopaedic surgical procedures, it might be sensible in those settings to use local “physician extenders” for outpatient consultation and pre- and postoperative care. I predict that we will soon see manuscripts submitted to The Journal documenting the quality and cost-effectiveness of care delivered to “geographically disadvantaged” patients in those alternative ways as well.
Marc Swiontkowski, MD