Friday, January 09, 2009

Rural Surgeons--Endangered Species

This caught my attention last week: Shortage of General Surgeons Endangers Rural Americans by David Brown Washington Post, January 1, 2009. In Pocahontas County, like much of rural America, doctors are few and hospitals are far away, so of course, I read the article. Imagine my surprise to find that they chose to profile the general surgeon from my hometown, Creston, Iowa.

...Robert Kuhl has started his chores, too. The first is fixing the broken hip of a 94-year-old widow who fell the night before. Like so many of the 7,500 people in Creston, she would rather have the operation where she lives than in a big city miles away.

Through an incision in her thigh, Kuhl will saw off the broken end of the femur and replace it with a metal one that fits the joint socket. The procedure is called a hemiarthroplasty. Kuhl is the only person in an 80-mile radius who can do it. It will take him about 90 minutes.

I've never met Dr. Kuhl (I left the state for grad school about the time he started his practice in Creston.), but he replaced my mother's hip 16 years ago, and she made a remarkable recovery. A big part of it was treatment close to home, which, according to this article, is bound to become a scarcer commodity.

For the one-quarter of Americans who live outside metropolitan areas, general surgeons are the essential ingredient that keeps full-service medical care within reach. Without general surgeons as backup, family practitioners can't deliver babies, emergency rooms can't take trauma cases, and most internists won't do complicated procedures such as colonoscopies. But various forces -- educational, medical and sociological -- are making them an endangered species....More than half of rural general surgeons are older than 50, and a wave of retirements is expected in the coming decade.


Larry said...

During my decades in rural Knox County, MO, there were small-town clinics within a ten-mile radius, but surgery, childbirth, and suchlike were only available forty miles away in the nearest mid-sized towns.

The small-town clinics were (and probably still are) staffed by osteopaths from Kirksville,the original home of osteopathy. Many of my neighbors back then were suspicious of osteopathy and would drive long distances to receive care from "normal" doctors. Both of my children were delivered by osteopaths, and there was no bone-manipulation involved; I think that osteopaths receive good basic medical training and most of them seem to have shed the osteopathic dogmas in the interest of their patients' health.

Rebecca Clayton said...

West Virginia School of Osteopathic Medicine is just about 25 miles from here, and many (if not all) the physicians in Pocahontas County are osteopaths.

It seems as though the osteopaths get pretty much the same training as "regular" doctors these days. WVSOM is remarkable in that it's tuition will not throw you into a lifetime of crushing debt, so that you can afford to be a small-town doctor at small-town fees. I've never had a chance to ask my doctor about cranial manipulations--her waiting room is always full.