A model for internal medicine physicians in a small rural hospital.

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A model for internal medicine physicians in a small rural hospital.

Rural Remote Health. 2018 Aug;18(3):4419

Authors: Bunge P

CONTEXT: Finding providers to work in the hospitals and clinics in the small towns of the USA 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.
ISSUES: 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 10-bed hospital in Washington State. The hospital is located in a town with a population of about 3100, in a county with an approximate population of 70 000 people. 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 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 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 3 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.

PMID: 30098590 [PubMed - in process]

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