"Hospital occupancy has a lot to do with how many physicians there are. And right now we have a major shortage of general surgeons," Schneider said in an interview. That problem—along with a lack of specialists in general—is exacerbated in rural areas. "Now, many of those patients have to come to the more urban areas to get the simple operations done."
She points to Rochester, NY, where's she's also a professor of emergency medicine at the University of Rochester, which is surrounded by several very rural communities.
"We see a lot of patients coming to our hospital for relatively simple types of procedures," she said. "Relatively straightforward orthopedic problems, for example."
Moreover, many rural physicians may not take ED calls for a variety of reasons—higher malpractice insurance rates, a reluctance to be called throughout the night and have to work the next day—causing patients to be transferred to other facilities.
"If you need your appendix out at night, there may be a general surgeon in town, but he may not take call for the emergency department," Schneider says.
Perhaps these findings will serve as a catalyst for policymakers and others who can help allocate additional resources to help struggling rural organizations keep their EDs viable.