The Visiting Specialist Model of Rural Health Care Delivery: A Survey in Massachusetts

University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
The Journal of Rural Health (Impact Factor: 1.45). 02/2006; 22(4):294-9. DOI: 10.1111/j.1748-0361.2006.00049.x
Source: PubMed


Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists.
To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of satisfaction and intention to continue the visiting arrangement.
Visiting specialists at 11 rural hospitals were asked to complete a mailed survey.
Visiting specialists were almost evenly split between the medical (54%) and surgical (46%) specialties, with ophthalmology, nephrology, and obstetrics/gynecology the most common specialties reported. A higher proportion of visiting specialists than specialists statewide were male (P = .001). Supplementing their patient base and income were the most important reasons visiting specialists reported for having initiated an ancillary clinic. There was a significant negative correlation between a hospital's number of staffed beds and the total number of visiting specialists it hosted (r =-0.573, P = .032); study hospitals ranged in bed size from 15 to 129.
The goal of matching supply of health care services with demand has been elusive. Visiting specialist clinics may represent an element of a market structure that expands access to needed services in rural areas. They should be included in any enumeration of physician availability.

Download full-text


Available from: Judith A Savageau,
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Small towns across the United States struggle to maintain an adequate primary care workforce. To examine factors contributing to physician satisfaction and retention in largely rural areas in Massachusetts, a state with rural pockets and small towns. A survey mailed in 2004-2005 to primary care physicians, practicing in areas designated by the state as rural, queried respondents about personal and practice characteristics as well as workforce concerns. Predictors of satisfaction and likelihood of remaining in current or rural practice somewhere were assessed. Of 227 eligible physicians, 160 returned their surveys (response rate, 70.5%). Approximately one third (34.0%) reported they had grown up in communities of 100,000 or larger. Factors associated with higher overall practice satisfaction included not feeling overworked (P = .043) or professionally isolated (P = .004), and being involved in their practice (P = .045) and home communities (P = .036) as well as ease of seeking additional physicians for practice and obtaining CME credits (P = .014 and P = .017, respectively). Female physicians were more likely to report an intention to remain in rural practice somewhere for the next decade (P = .034). In rating their satisfaction with various aspects of the rural practice environment, physicians reported greatest satisfaction with their practice overall (67%) and their call group size (66%). They were least satisfied with their current (30%) and likely future income (40%). In multivariate analyses, larger practice community size was positively related to the dependent variable of overall satisfaction and negatively related to likelihood of staying in current practice or in rural practice somewhere. Our findings reaffirm the importance of rural medical education opportunities in physician recruitment, retention, and practice satisfaction. They also indicate that in a small New England state, a major source of physicians for rural and small town communities is physicians who have been raised in urban/suburban communities and who were trained outside of the region but who were prepared to live and to practice in rural and small town communities.
    The Journal of Rural Health 02/2008; 24(4):375-83. DOI:10.1111/j.1748-0361.2008.00184.x · 1.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The supply side of many professional service markets consists of two different pools of providers: generalists and specialists. Specialists usually gain access to new clients through referrals from generalists. To ensure a continuing stream of engagements, specialists often form referral alliances with multiple generalists. Engaging the right generalist partners and allocating resources to the resulting referral relationships are among the most important challenges facing these specialist firms. In this study, we examine how competition affects the management of referral alliances over time. Because of the high level of inseparability of the professional service engagement, the nature of competition among specialists is complex. Building on the ecological view of competition, we model the degree of niche overlap in the specialist's home markets and the generalists' markets as well as the potential overlap due to the proximity of rivals vis-à-vis generalists. Using data on visiting consultant clinics involving cardiology specialty practices and rural hospitals from a Midwestern state over a 13-year period, we find that the various aspects of niche overlap influence the involvement of these specialist professional service firms in referral alliances as well as resources they allocate to these relationships. In addition to expanding our understanding of vertical, bilateral alliances between professional service firms, this study enhances our general understanding of strategic alliances by demonstrating how partner attractiveness and the actions of rivals affect the resource allocation decisions of firms managing multiple strategic alliances over time.
    Organization Science 02/2010; 21(1):216-231. DOI:10.1287/orsc.1090.0448 · 4.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Proximal femoral fractures are common in the elderly. The best care depends on expeditious presentation, medical stabilization, and treatment of the condition. We investigated the risk of increased mortality in residents of rural communities secondary to inaccessible facilities and treatment delays. We used Medicare Provider Analysis and Review Part A data to identify 338,092 patients with hip fractures. Each patient was categorized as residing in urban, large rural, or small rural areas. We compared the distance traveled, mortality rates, time from admission to surgery, and length of stay for patients residing in each location. Patients in rural areas traveled substantially farther to reach their treating facility than did urban patients: mean, 34.4 miles for small rural, 14.5 miles for large rural, and 9.3 miles for urban. The adjusted odds ratios for mortality were similar but slightly better for urban patients for in-hospital mortality (small rural odds ratio, 1.05; large rural odds ratio, 1.13). Rural patients had a favorable adjusted odds ratio for 1-year mortality when compared with urban patients (small rural odds ratio, 0.93; large rural odds ratio, 0.96). Rural patients experienced no greater delay in time to surgery or longer hospital length of stay. Although patients living in rural areas traveled a greater distance than those living in urban centers, we found no increase in time to surgery, hospital length of stay, or mortality. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 10/2011; 470(6):1763-70. DOI:10.1007/s11999-011-2140-3 · 2.77 Impact Factor
Show more