When Jonna Cubin, MD, was a junior resident, she remembers just two people attending the American College of Emergency Physicians' Rural Emergency Medicine section meeting. These days, more than 100 participate, which she credits to the section's influence.
“The ACEP section has provided a platform for the rural physicians to create a sharing atmosphere,” said Dr. Cubin, the new chair of the section. “While we are still under-recognized and underutilized, the section is providing a vehicle to do away with the sense of professional isolation and helping to curb burnout.”
Dr. Cubin noted that being able to promote rural emergency medicine among residents and medical students as a legitimate, reasonable subspecialty career has strengthened their numbers. “We need to break through the typical barriers encountered when it comes to rotating in rural emergency departments,” she said. “Our section can serve as a gateway to making contacts and organizing a network of contacts for those who are interested in a rural practice.”
The section is creating what stands to be the definitive work on rural practice, she said. A Survival Guide for Rural Emergency Medicine is an evidence-based official ACEP publication with some 40 contributors that will be available in print and mobile versions.
Harry “Tripp” Wingate, MD, the past section chair, said an emphasis on three themes will help the section and rural emergency physicians accomplish their objectives. First on the list is recruiting more rural emergency physicians by supporting ACEP's initiative to remove barriers to rural rotations and by advocating for all residency programs to have a required rural rotation. He said the rural section should participate more with the Emergency Medicine Residents' Association meetings, and supply a regular column about rural opportunities in EMRA communications.
Dr. Wingate also advocated promoting rural emergency medicine research and using the section website as a clearing house for that research. He said the section should hold a research forum to identify research questions and set up a research network of hospitals to expand the power of questions being studied. Rural emergency physicians would also benefit, he said, by having educational resources such as podcasts and online educational products, by creating an affiliate membership status for non-ACEP members practicing full-time rural emergency medicine, and by supporting due process rights.
Most of those interested in rural emergency medicine practice in small towns, but Jeff Coben, MD, a professor of emergency medicine at West Virginia University, has never worked in a rural setting. “I'm from Philadelphia, a city boy with clinical practice in urban or suburban areas like Morgantown,” he said. But he is a top advocate for using communications and technology to support rural emergency medicine. “WVU has gotten some of the largest federal grant dollars to establish the health network throughout the state via informatics. It's coming down the pike. No longer will rural EDs be isolated without access to patient records or consults; they'll be hooked up. Even the most rural places have computers and Internet access so they will have the ability to tap into this new system and access the network.”
His colleague, Todd Crocco, MD, an associate professor and the chair of emergency medicine at WVU, agreed that technology presented a “tremendous opportunity” for rural emergency physicians. “Telemedicine continues to grow as technology capabilities increase. These are exciting times, and we should expect close collaboration between institutions in order to deliver the best care possible for our patients,” he said.
Dr. Crocco said emergency physicians at tertiary care centers have a responsibility to help their counterparts in the rural setting. “Let's face it. Many referral patterns already exist throughout the United States. They evolved out of necessity for doing the right thing for our patients,” he said. In some instances, more formal relationships exist that evolved through the efforts of trauma societies, cardiac societies, and stroke organizations, he added.
Tertiary care centers can extend these collaborations to other patient conditions, such as sepsis and hand injuries as well, which also meets the outreach expectations many academic centers have for faculty, Dr. Crocco said.
Edwin Leap, MD, rural emergency physician extraordinaire, said he would like physicians, particularly academics, to be more willing to embrace rural culture and work to enhance rural emergency medicine through education and rotations. “So often there's a sense that rural people are inferior or less educated. I can speak to the falsehood of that claim,” he said.
Dr. Leap also called for greater cooperation between large and small centers, especially to expedite transfers without a culture of blame or condescension. “It's much better here in South Carolina now, so I know it's possible,” he said. “After all, in an era when everyone is trying to capture revenue, rural patients pay their bills, too.”
The key here is cooperation. If every emergency medicine residency program partnered with a rural hospital ED, imagine the results. Patients get the best care, residents have the opportunity to refine their skills, academic programs enhance their training scope with rotations in a different environment, and the country gains a connected, more cohesive practice of emergency medicine. Everybody wins.
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▪ Learn more about ACEP's rural emergency medicine section at http://bit.ly/RuralACEP.
▪ Read all of Ms. Katz's past columns in the EM-News.com archive.
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