"If it isn't, they need to be thinking about it," he says. "This is a big issue because it ties in with the attractiveness of primary care in rural hospitals. If you don't have the surgical backup it's harder to get primary care providers. It ties in with the trauma system in rural areas; it ties in with the financial viability of services provided."
He believes that rural hospital administrators should take the lead in thinking about what "they need to produce locally and what would better fit within a more standardized referral network." For example, executives might consider using traveling surgeons to perform scheduled procedures and local surgeons who are available for emergency back-up. In addition, he says rural hospital executives should work closely with referral hospitals about coordinating care.
"What I have is a small piece of a bigger puzzle, which is: How do you produce the workforce that's needed in rural areas, and how do you create the right climate to attract surgeons in rural settings?" says Doescher. "A lot of that's medical education overall, but the rural hospitals have a big piece on trying to figure out how that make that a manageable career choice."