he Committee on Rural Access to Anesthesia Care is proud to announce a new ASA scholarship program for medical students studying anesthesiology in rural areas. The ASA House of Delegates approved a pilot program on October 18, 2006, for $10,000 per year for three years. Medical students will be able to apply for scholarships to pay for expenses up to $750 for travel and lodging for a rural clerkship. Details will be provided on the ASA Medical Student Delegation Web page in January 2007. If anyone knows of an organization or foundation that may match the ASA funds for this rural medical education program, please contact me. Thank you to all the many people who have made this opportunity possible for medical students to experience rural anesthesiology.

The Committee on Rural Access to Anesthesia Care presented a panel discussion at the 2006 Annual Meeting in Chicago. John C. Chatelain, M.D., North Dakota, reviewed the basic demographics and definitions of rural America. He reviewed the history and current status of the rural geographic practice cost index (GPCI) on Medicare payments. In 2003, Congress approved a temporary equalization of rural work GPCI to raise Medicare reimbursement in rural areas toward the national average payment. This congressional act for equalization of payments sunsets in December 2006. Without congressional action for an extension, 2007 will return to the deep discounts for Medicare services in rural America.

Dr. Chatelain explained that 25 percent of the U.S. population lives in rural areas, but only 12.5 percent of the surgeons practice in rural areas. Accurate data for the percentage of anesthesiologists practicing in rural areas is not available but is estimated to be less than 5 percent of the total number of practicing anesthesiologists in America. Dr. Chatelain described the challenges and benefits of rural living while providing necessary care to an aging population.

Wallace H. Good, Jr., M.D., Vermont, described a unique program to meet the needs of rural anesthesiologists, hospitals and patients. Dr. Good calls this approach to an anesthesiology practice “spinning.” The need for regular part-time anesthesiology staff in a rural region to cover the operating rooms and nonclinical time for local anesthesiologists is always present. He explained the benefits of spreading the knowledge of “best practices” throughout a region with these webs of anesthesia practice. Dr. Good explained how the issues of availability, scheduling, compensation, insurance, local hospital cultures and different medical staff regulations could be navigated. He outlined the benefits of working in multiple facilities with access to different recreational experiences. He shared stories of the fishing, hiking and skiing available near these facilities.

I described our hospital’s successes with a new process for preoperative workups for patients who may travel more than 500 hundred miles roundtrip for their surgery. Several years ago, the facility experienced a more than 20-percent cancellation or delay rate the day of surgery for the operating room. This was reduced to less than 5 percent. Many patients previously arrived on the day of surgery with little or no preoperative medical evaluation. Now the preoperative process sets a target that all labs, consults, and history and physicals be completed 72 hours prior to surgery. Follow-up with the surgeon’s office by fax is now routine for every patient 24-48 hours prior to surgery to identify those patients with the preoperative process complete and any patient who still has specific data pending. Protocols were described to gather this information from sometimes distant facilities and physicians by fax, e-mail and telephone calls.

A unique electronic educational resource called OR PEER¹ was demonstrated. This simple software system can be used to develop education tools for new staff. OR PEER is a quick resource review that illustrates with photos and text the tasks that may be infrequently performed to increase confidence and job satisfaction for intermediate employees (only on the job for one to three years). These intermediate employees are critical to retain on your staff because they help to preserve knowledge for your institution’s future and the future of perioperative nursing. OR PEER also can quickly demonstrate to travelers how procedures are done in your local institution.

The goal is for rural facilities with limited staff to improve patient safety in the operating room or even other areas of the facility. The updated version of OR PEER <www.ORPEER.com> has the ability to test for competency and track the results for nurse continuing education unit credits or physician continuing medical education hours. This quick and easy electronic educational resource can speed your staff’s learning curve and enhance your organization’s experience curve.

Rural physicians recognize that without academic training programs, we will have no anesthesiologists to recruit to rural America. The Committee on Rural Access to Anesthesia Care supports fair and equal payments for services provided by physicians in anesthesiology training programs. The Resident Component House of Delegates has passed a recommendation to study the feasibility of anesthesiology residency rotations in rural areas.

Nationally, family practice programs have led the way in rural training, and general surgery has developed residency training for rural practices. If Medicare reimbursement for medical care to academic programs improves, anesthesiologists can follow this pathway to rural America.

Reference:
1. Schweitzer MP, et al. An electronic educational resource. AORN Journal. June 2006; 83(6):1374-1383. <www.ORPEER.com>.

Mike P. Schweitzer, M.D., is Medical Director of Perioperative Services, St. Vincent Healthcare, Billings, Montana.