At this rural hospital, staffing shortages and telehealth visits have become standard
At this rural hospital, staffing shortages and telehealth visits have become standard
The World Health Organization has declared the end of the COVID-19 global health emergency, and the U.S. is scheduled to follow suit Thursday. Yet even as pandemic-era policies draw to a close, the health care industry has been changed for the long haul — especially rural providers.
Dr. Eric Henderson is an orthopedic surgeon at Dartmouth Hitchcock Medical Center, a hospital based in Lebanon, New Hampshire, a city of about 15,000 residents as of 2021. Henderson’s patients come from farther afield, some driving four hours for care. “As my former boss said, 85% of people in the U.S. live within five minutes of a CVS,” Henderson said, “and we care for the other 15%.”
Since the pandemic, Dartmouth Hitchcock has dealt with tremendous staffing shortages, but mainstream acceptance of telehealth has revolutionized its services. “Marketplace” host Kai Ryssdal spoke with Henderson about his practice. The following is an edited transcript of their conversation.
Kai Ryssdal: For those perhaps unfamiliar with medicine as a field, what exactly is it that you do?
Eric Henderson: I am an orthopedic surgeon by trade. I did a fellowship in oncology, and so I care for patients who have primary bone and soft-tissue cancers, which are known as sarcomas. And then for patients who have cancers that metastasized to bone.
Ryssdal: So talk to me about who your patients are then. Who comes to see you?
Henderson: I am as likely to see a biotech entrepreneur as a dairy farmer. And so my patients run the gamut. And some of them drive up to four hours to be here. And as my former boss said, 85% of people in the U.S. live within five minutes of a CVS, and we care for the other 15%.
Ryssdal: Yeah. So, let’s do a little nuts and bolts before we actually get into the reason we called you, which is, which is sort of the practice of medicine in a rural environment, which, after the pandemic and all the challenges medicine has had, it has to be a special challenge. But let me ask you a couple of basics. First of all, staffing. Do you have enough people working for you? Can you find people to help you do orthopedic oncology?
Henderson: We have 1,800 job openings right now for our health system. And we have about 13,000 total employees, and so we have openings for about 15% of our workforce.
Ryssdal: For the people who are there, that doesn’t seem sustainable.
Henderson: Well, you know, the magic trick is that every day we show up to work and we’re able to stick the landing for high-complexity care. But the problem is we have become highly reliant on traveling nurses and traveling staff. And you’re right, that is not sustainable.
Ryssdal: Technology has come into play in medicine in this pandemic like we haven’t really ever seen. Can you do orthopedic oncology on telemedicine? I’m sure you can do consults and stuff, right?
Henderson: Yeah. I would say that the advancement of telemedicine has been the single biggest change in most of our practices, and especially my practice. Much of my medical decision-making is based around radiological imaging. And so prior to the pandemic, I was not really empowered to call someone up and say, “Miss Jones, your imaging shows a benign tumor. I think we can reimage this, we don’t need to biopsy it.” And the changes in the rules around telemedicine has made that much more acceptable.
Ryssdal: And easier, I imagine, for patients and for you.
Henderson: Yes. Our institution has leaned heavily into telemedicine. And to put some numbers on that, prior to the pandemic, with about 7,000 outpatient clinic visits per day, we had eight to 10 total telemedicine visits per day, so about 0.1%. And at the pandemic peak, we topped out at 2,600 per day. And we’ve now reached an equilibrium somewhere in the 700 range.
Ryssdal: OK, so this one’s a little sideways, but roll with me here. You are a person of science, right? You are trained in the sciences, which, which is required for your job, yet your job also requires you to interact with people at what may well be the worst day of their lives. How do you do that?
Henderson: Yeah, I think that’s true of so many people in medicine, whether the patient has an obvious cancer or not. You need to understand that by being referred to see me, that that alone causes an extreme amount of anxiety. And so 90% of my job is talking people off the ledge and telling them they don’t need to be there. But you’re right. It requires empathy. And that is not necessarily in the textbooks for medical school.
Ryssdal: Can you leave it at the office, or no?
Henderson: No, it’s not possible to leave it at the office. I don’t know anyone who can, but I think that trying to leave it at the office would be a mistake.
Ryssdal: Why so?
Henderson: Well, I mean, the surgeries that I do require oftentimes weeks of planning. I called a patient recently. His surgery was the following week and I was home with the kids and had an idea Saturday morning about how we could change things up from what we had talked about. And I called him up at home and said, “You know, hey, Mr. Smith, you know, sorry to surprise you, but I just had this idea. I know your surgery is Monday morning, I want to run this by you.” And we made a change, and it worked out. So you can’t turn it off.
Ryssdal: Without casting aspersions on Dartmouth at all, if you could be in practice in Boston or Seattle or Los Angeles, would you give up the rural part of this job?
Henderson: Well, I can tell you I’ve had that opportunity. And you know so far, I really love where I am. Out my back door window, I can see mountains 30 miles away and watch the sunset rise over them. And, you know, it’s interesting you bring that up because the greatest things about living where we live are also the things which make practicing medicine here the most difficult. We live in one of the most beautiful areas in the country. And yet because of the ruralness, which, which makes it beautiful, we have more trouble staffing and etc., etc.
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