case, maybe hundreds of miles
away, is a competent and collegial
surgeon who is going to partner
with us for postoperative care and
management of complications.
We bring patients in from around
Montana several times a week,
and herein lies the benefit that
our administration now realizes.
Until the development of the
RS3 collaborative model, these
patients would have left Montana,
leaving behind distressed families
and strained CAH bottom lines.
We view our program, RS3, as
an extreme value—a win-win-win-win for the solo surgeon,
the patient, the CAH, and our
program. The solo surgeon has
established lines of support, the
patient can stay close to home,
the CAH is buoyed by the patient
retention and is a referral line,
and we get to practice tertiary,
complex surgery on our terms
in a collegial environment.
Easy to reproduce model
Our administration concurs
that by directly supporting rural
surgery practices, we contribute
to the viability not only of the
surgeon in that community,
but the hospital that serves the
community, and to the quality
of surgical care in Montana.
The model is easily reproduced
and can be applied to almost
any surgical subspecialty. This
program is not outreach, where
you travel to a clinic sparsely
attended in some remote location
and bring the patients to your
hospital for care. That model is
of minimal value to the CAH,
and only serves to drain patients
from their system. The RS3
fosters a partnership amongst
practices and administrations.
Old models of competition are
obsolete in Montana and collegial
professional relationships that
benefit our population are
replacing them (see Figure 1, page
62). Our view is that this model
of care will make rural surgery
practice in Montana appealing
and sustainable for years to come,
and we have noted successful
recruitment of young surgeons
in the state, at least in part due to
the established support networks.
How do you make it work?
First, you must have some good
partners who see the greater
good in such a program. By no
accident, my partners all have
the same vision. You must have
a “just say yes” policy, which
essentially means that any case
the solo surgeon needs help
with, for any reason, is dealt
with promptly regardless of
whether the patient is insured,
uninsured, addicted, experiencing
postop complications, and so
on. The bottom line is that if a
surgeon is calling (or texting,
nowadays), he or she needs help.
Your institutional
administrators might need some
education and likely some eye
opening before implementing
a similar program. But aside
from institutional buy-in and
support, the solo rural surgeons
must want your support and ask
for help when needed. If you
boil it all down to what is best
for the patient, irrespective of
money, the answer is clear.
I welcome your comments,
criticisms, or questions and
can be reached on the Rural
Surgery ACS Community
listserve or directly via e-mail at
david.sheldon@mac.com. ♦
JUL 2017 BULLETIN American College of Surgeons
| 63
DISPATCHES FROM RURAL SURGEONS
“Many rural critical access hospitals provide
high-quality care, but we have limitations on
our abilities due to resources, size, or geographic
location. Through our collaborations with the
group at Kalispell Surgical Specialists, I have been
able to keep up to date and expand my practice,
keeping more patients close to home during
their treatment in an often-stressful time.”
—Jennifer Stevane, MD, FACS,
general surgeon,
Community Hospital of Anaconda, MT Dr. Stevane
