2 Qs about spine specialist practice in rural areas

Written by Shayna Korol | March 18, 2019 | Print  |

Specialist practice in rural areas poses unique difficulties and opportunities. 

Andrew Lederman, MD, is an interventional physiatrist at The Aroostook Medical Center in Preque Isle, Maine. He recently spoke with Becker’s Spine Review about challenges and opportunities facing rural practitioners.

Question: What challenges do spine specialists face in rural areas?

Dr. Andrew Lederman: In general, practicing medicine in a rural area poses several challenges. The most critical [challenges] are recruiting and retaining physicians, long distances between patients and rural hospitals and limited resources on the part of both the patient and rural hospital.

There are specific challenges as well as opportunities pertaining to working as an interventional physiatrist in a rural area. Most of my practice focuses on procedure-based treatments for chronic pain, often arising from spinal pathology.  I live in a city with approximately 10,000 people and work in an outpatient hospital setting that serves most of the surrounding county of approximately 70,000.  One of my challenges includes the lack of a spine surgeon at my hospital – the closest is a two-hour drive south or emergency flight away.  Spine surgeons are often consulted remotely, and this type of interaction is quite limiting given the inability for the surgeon to physically be present to perform a physical exam and interact with the patient. Once it has been determined that a patient does not require emergency surgery, as is often the case, patients will then be referred to the spine surgeon’s office to be evaluated far away for conditions rarely requiring surgery.

There is also a supply and demand problem created by the confluence of three major factors: an aging population, worsening physician shortage and ongoing pursuit of non-opioid treatments for chronic pain. Original models of managing chronic pain, like many other conditions, relied heavily on primary care providers to evaluate and treat pain within their scope of practice and then to refer if refractory. 

Often this referral would be to a spine surgeon. However, due to the increasing volume of patients and frequent non-surgical nature of chronic pain, this resulted in surgeons being overwhelmed with office visits for patients often not requiring surgery. This ultimately reduced the efficiency of surgical practices because they were therefore forced to triage their referrals and prioritize those patients in which they could maximally help. As a result, patients were sent back to their primary care provider where their treatment algorithm had previously been exhausted.

Q: How can physiatrists best partner with spine surgeons?

AL: Physiatry can provide effective coverage for the gap in the preexisting referral and treatment process. Physiatrists, and interventional spine specialists in particular, can triage those who would benefit from the services of a spine or neurosurgeon.  For example in my current practice, I have carved out a role of primary provider for all conditions related to pain, spine or otherwise.  In this role I am serving an unmet need for the population to diagnose painful conditions, offering treatments that truly exhaust non-surgical options, and am able to refer when appropriate.  

I partner with spine surgeons in my area to curate or refine referrals, so surgeons can operate at the top of their license and see more surgical patients.  This ultimately increases the efficiency of their practice and their profit margin.

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