James Cook University ISSN 1445-6354
Context: Finding providers to work in the hospitals and clinics in the small towns of America is a significant struggle. In the traditional model, the primary care doctor sees patients in the inpatient setting in addition to a clinic practice. In the usual hospitalist model, providers specialize to work only in the inpatient setting.
Issue and project: Rural communities often lack the resources, facilities, and volume to safely adopt the usual hospitalist model, which has its own disadvantages. Small town hospitals have found several ways to find a middle ground between the two models. A provider staffing model is described that utilizes internal medicine physicians to provide inpatient and consultative outpatient care in a rural ten-bed hospital in Washington State. The hospital is located in a town with population of about 3100, in a county with about 70,000. It has a 24-hour emergency room, three primary care clinics, urgent care, x-ray, pharmacy, and laboratory capabilities. In this model, the internist on duty provides care in the inpatient unit and in the afternoon sees patients consulted from primary care providers, as well as follow-up patients from the emergency room (ER) and the inpatient setting.
Lessons learned: The model potentially increases access to a higher level of care in the rural setting. It potentially provides work that for the provider that is interesting, satisfying, balanced, purposeful, and appropriate to their training level. Specific norms, standards, and leadership are key to functionality, including some continued experience in a larger hospital. The model has been functioning successfully for more than three years. The potential cost savings over the usual hospitalist model are substantial. The model could be used in other locations and in training internal medicine physicians in the rural setting. Research in this area could include randomizing communities to this and other staffing models and following the care given and the health of the community members over time.