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Second Opinion: Small Hospitals Critical but in Danger

Leap, Edwin MD

doi: 10.1097/
Second Opinion

Dr. Leap is a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of three books, Working Knights, Cats Don't Hike, and The Practice Test, all available at , and of his own blog, . Follow him @edwinleap, and read his past columns at



I was lucky to have the opportunity to fly with LifeLine when I was a resident at what was then Methodist Hospital of Indiana. I am originally from West Virginia, where rural means mountainous, but I came to love the beautiful, stark emptiness of Indiana as seen from the sky. Over time, I came to truly appreciate the small, rural hospitals that called us for help at all hours of the day and night.



I wish I had a log of all the towns and facilities we visited by air, landing on remote helipads on winter days or on lonely roads in the frantic, alcohol-soaked days of summer car crashes. Those scenes remain with me and always will. From farm accidents to burns, cardiac events to electrocution, and everything in between, I came to appreciate the loneliness and anxiety that first responders and even physicians experienced in remote areas. It was wonderful to be able to come to the aid of providers and patients, not because the providers were inadequate; they were just doing hard work in places with fewer resources. And we were the cavalry.

It seems, however, that my actions were almost a prophecy of my future. I spent 20 years working in rural South Carolina being the guy in a fairly busy small emergency department who called helicopters for trauma, burns, MI, ruptured aortic aneurysms, and all the rest. Sometimes the best thing in the world was watching that helicopter lift off, and going back inside to finish the paperwork.

But now I've taken another step. Moving further out and away, I've started a career in locums medicine. I find myself in ever-smaller hospitals in ever-smaller towns. And some of that work has brought me full-circle back to Indiana. A Leap ancestor, buried just north of Indianapolis in the early 1800s, is smiling down on me, farmer, vintner, and soldier that he was.

I love what I'm doing because I see how vitally important small hospitals are to the communities they serve as I get older and travel the back roads more and more. And this is nowhere truer than in Indiana. Despite the wonderful cities and towns of the state, it is a very rural place, and its people are tied inextricably to the land, the farms, the factories, and their own ancestry in this former frontier, which retains some of the same expanse and emptiness of its past.

The small hospitals in the small towns of Indiana (and in many states) were born of a kind of pioneer expediency, in which the local doctor in the local facility cared for the people he loved in the place he loved.

These places are in danger, however. American hospitals today tend to form large conglomerates. It's no wonder in the complexity and competition of modern medicine, in which a vast bureaucracy and huge corporations struggle for dollars. But it raises costs all around, as the article, “Your Hospital Bill is About to Get a Lot More Expensive,” suggests. (

Unfortunately, one of the side effects of those costs is that it is more and more difficult for small hospitals to compete. It is likely many small facilities will close in the not-too-distant future, and this is an eventuality that many in urban areas don't really understand. For them, hospitals compete. There's always another one within 15 or 20 minutes at most. But for those in rural areas, their wee hospital, in the old building, is more than a hospital. It's a mission post. It's a fortress of safety for their sick children or injured spouse. It's the only game in town.

That's something I'm seeing more and more. The small hospitals of America all matter, whether they are in Indiana, South Carolina, Kentucky, or Illinois. It matters that they have funding for talented and qualified staff, that they have help from larger centers in transfer agreements, that they have funding (and helipads). It matters that they remain open.

I don't have a crystal ball, of course, but I do know that our country and every state in it has to do its best to save the small hospitals of the land. The places where ranchers and farmers, factory workers and loggers, sportsmen and miners, and all the rest (and their precious families) live and work.

They may be in “flyover country” to some. But I've flown over it and landed in it and seen the sick and dying there. Those folks deserve the same health care as everyone else. And we can't let anyone forget it.

This post originally appeared in Dr. Leap's blog.

© 2014 by Lippincott Williams & Wilkins