Robert Jackson, DO, is a practicing rheumatologist and president of Premier Specialty Network. His company works with more than 30 rheumatologists, who provide services to more than 60 rural hospitals in six states. The Rheumatologist recently asked Dr. Jackson to comment on the future of rheumatology in rural areas.
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Q: What do you see as the future of rural rheumatology between now and 2021?
A: I don’t think that the need for our specialty in rural areas is going to lessen. Instead it will increase. This demand will, likely, keep reimbursement levels competitive and make it a good business model to go outside the city.
Q: There is a concern that government healthcare reform was not favorable to rural locations, and a number of rural hospitals have closed. How does that fit in with the scenario you seem to see?
A: [That has been] unfortunate. … There are many areas with only one hospital left. Losing that facility can have a [devastating] impact on communities both immediately, as one of the area’s largest employers, and longer term [because the] lack of a hospital can make it harder to bring in new employers.
Because of this, I think political pressure on, and by, both parties will [create] an incentive for Congress to keep small hospitals alive even as the rest of the government seems to be applying pressure to close them.
In some areas, they may be lost as a provider of in-patient acute care services, but in most cases, they will still be providing outpatient and urgent care [services]—some of which can be provided by rheumatology specialists.
Q: What are some of the other pluses you see in this area of practice going forward?
A: Technology is likely to get better in rural areas. This [fact] will mean top-level care is available quicker and easier in rural and suburban areas and increase the ability of practitioners to make good professional decisions. It should also help with concerns about professional isolation.
Q: Speaking of technology, you seem to suggest that electronic medical records (EMRs) are somewhat of a two-edged sword.
A: The old way of closing down your office, grabbing your paper records and driving down the road to another community is not all that productive. On the other hand, it isn’t unusual for a rheumatologist to practice at more than one hospital, with limited ability to exchange information between them, and each may have different ways of entering information.
Since I “retired”, I have been busy as an in locum rheumatologist and have worked in rural locations for the first time in my career in Illinois and Wisconsin rather than in urban Nashville and Central Florida where I now live. The EHR has been a game-changer in many respects. One of the issues is that PCP’s now serve more of a triage service and appear to have diminished abilities in the diagnosis and management of a number of rheumatologic/orthopedic but non-immunologic conditions. I would characterize their deficiency as being in “musculoskelelatal medicine”. With the increasing retirement of rheumatologists and the medical/administrative duties associated with managing complex patients on immunosuppressive medications, rural rheumatologists do not have the capacity to see large numbers of non-specific and non-immunologic conditions. Moreover, the use of physician extenders only lowers the bar further in regards to expertise in diagnosis and management of musculoskelatal complaints. I suspect that telemedicine will be needed in rural areas where patients have to drive for 1-2 hours for their appointment.