From oncology to orthopedics, these specialists periodically leave their practices in places such as Missoula and Kalispell and head out into rural western Montana to see patients.
It seems ideal - say you live in Hot Springs, and have had a hip replaced. It's certainly much easier to make it the 15 miles to Plains for follow-up visits with your physician than it is to make a 120-mile round trip to Missoula every time.
Wrong, says Dr. Dean French, chief of medical staff at Clark Fork Valley Hospital in Plains.
“It may seem Mother Teresa-like, but it's not,” French says. “I can give you example after example of how it hurts rural hospitals, and zaps their resources.”
There are, French says, visiting physicians who are very committed to the communities they drop in on from time to time.
They are, he says, wonderful.
And rare.
“One of the great challenges in rural medicine is how to get specialists into rural areas,” he says. “The traditional model is you get a doctor who's setting up a practice in an urban area. You get him to come to Superior or Plains or Anaconda or Deer Lodge or Salmon, Idaho, a couple times a month. It's a great way to build a practice, and for a rural hospital it works in some ways, but in some ways it doesn't.”
What happens too often, French says, is that a traveling doctor will spend a couple years making the drive to Plains or Salmon or Deer Lodge, building up a patient base not only in those communities, but back home in Missoula as well.
“After a couple years, that drive starts getting old,” French says. “So they write their patients a letter saying, ‘I won't be coming anymore - but I'd be happy to see you in Missoula.' ”
Many patients will have formed a relationship with the doctor, French says, and are understandably not interested in switching physicians.
“What's that do to a rural hospital?” he says. “Now the CAT scans, the X-rays, the labs that were being done in the rural hospital - the things we depend on to exist - are not being done in Plains, they're being done in Missoula.
“Or say you have an orthopedic surgeon who is part-owner in a surgical clinic in Missoula who visits. When it comes time for surgery, we have the equipment in Plains, but he tells you it'll be faster and easier if it's done in Missoula. It's a double-edged sword.”
It's time, French says, to build a better mousetrap.
And with the help of St. Patrick Hospital in Missoula, they're trying.
On Jan. 7, Clark Fork Valley Hospital will get its first Plains-based cardiologist.
Dr. Sharon Nichols of Orlando, Fla., has been hired to open Clark Fork Valley Cardiology.
She will be affiliated with St. Pat's International Heart Institute, which previously provided visiting cardiologists for Plains and does for several other smaller communities.
But Clark Fork Valley Hospital will be her employer. The heart institute will purchase her services to provide outreach to Polson and Superior, and provide backup for her when necessary. The idea, French says, is that instead of a doctor taking time out from his or her Missoula practice to drive to an outlying area, the outlying area will be Nichols' full-time concern.
“We wanted a cardiologist to take ownership in the hospitals,” French says.
Nichols will spend two days a week in Plains, two in Polson and visit Mineral Community Hospital in Superior twice a month. It doubles the time visiting cardiologists have been spending in all three communities.
“This hospital decided a long time ago that rather than being a Band-Aid station, we wanted to be a community hospital with quality and consistent care so that people didn't have to drive 80 or 90 miles to get it,” French says of Clark Fork Valley Hospital. “Let's grow and develop so that we're more than emergency rooms with nursing homes attached.”
In Polson, according to St. Joseph Hospital CEO John Glueckert, quality was never a concern under the old system, but consistency was.
“We had three different cardiologists from the International Heart Institute visit once a month,” Glueckert says. “It isn't that they aren't all good, because they're all excellent. But each one had a different practice style, and each one had a different way they approached patients.”
And that can be a challenge for patients, who might see one cardiologist one week and a different one the next.
Now, with Nichols coming on board, heart patients in Polson will have the same physician every week, all year long.
Nichols and her family wanted to get out of urban Orlando and into a smaller community, and she was concerned that the medical group she is associated with in Florida was becoming more and more focused on “revenue streams,” according to French.
Her husband, once an alternate on the U.S. Olympic Ski Team, was “missing mountains and snow,” French says, and they were concentrating their search for a new community back East when a recruiter mentioned the opening in Plains.
“When she told her husband, all he said was, ‘When can we leave?' ” French says.
“She's on the phone every other day with ideas and thoughts,” he says. “She's excited about practicing in an environment where she can spend the time to manage people's health care, where it's not a factory environment.”
And French is very hopeful that in a couple of years, those patients won't be getting a letter telling them that if they want to keep seeing Dr. Nichols, they'll have to climb in a vehicle and hit the highway to do so.
Reporter Vince Devlin can be reached at 1-800-366-7186 or at vdevlin@missoulian.com.
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