Cavalier County Memorial Hospital is constantly seeking new ways to improve and upgrade their services to patients and, in their efforts to do so, have enlisted in the Rural Surgery Support Program.
By Melissa Anderson
This is a new program sponsored by the University of North Dakota (UND) School of Medicine and Health Sciences Department of Surgery to bring the practice of general surgery and referrals to the rural communities of North Dakota like those in Cavalier County and the region in general.
“We found one of the best surgeons who is working on this program. Dr. Mary Aaland and UND have the philosophy that surgery should be and can be done in the rural community,” CCMH CEO Chris Wyatt stated.
“We want to break the mind set that people have that they need to travel to the big cities to get surgeries and the best care. Up until the 90s surgeries and delivers occurred at rural hospitals. Now that isn’t happening and it’s killing critical access hospitals,” Wyatt added.
Dr. Robert Sticca, Chair of the UND Surgery Department, first realized there was a need for assistance for the surgeons in the rural North Dakota communities several years ago. Dr. Sticca worked to establish the program with assistance from the Healthcare Workforce Initiative, a program approved and funded by the North Dakota state legislature to improve healthcare for all residents of the state in 2014. Dr. Mary O. Aaland, a general surgeon who grew up on a farm in Northwood and is herself a graduate of the UND Dept. of Surgery, was recruited to lead and develop the program. Prior to taking the lead on the program, Dr. Aaland was primarily a trauma and critical care surgeon.
“In my former life I developed trauma systems. Now I am developing a rural surgery system of care,” Dr. Aaland said.
Overall, the nation is facing a shortage of surgeons in comparison to need especially amongst the aging population. As the increase in the aging population, the number one user of healthcare, grows the general surgery workload will increase by about 31.5 percent by 2020, significantly higher than the population growth during the same period. This increase workload and shortage of surgeons does not bode well for rural areas.
“The state of North Dakota has really had a vast shortage of surgeons even more so than the rest of the nation. As a result, four years ago I was approached to find a way to provide more surgery to rural ND,” Dr. Aaland stated.
The Rural Surgery Support Program, a principal component of the Division of Rural Surgery of the UND Surgery Department, was created and designed to aid rural hospitals and surgeons with the rural surgery practice issues in their communities.
“Dr. Robert Sticca, Chairman for the Dept. of Surgery, had the vision for this program. He saw a need, and now we are investing in our state from the university perspective to provide state of the art, board certified medical care,” Dr. Aaland stated.
In 2012, UND developed a program called Rural Track Surgeons, which is nationally recognized for training general surgeons to practice in rural communities. Since being established in 1982, the UND General Surgery Residency program has placed more than 40 percent of its graduates in rural practices. UND Department of Surgery continues to research and document the unique and challenging practice issues that confront rural surgeons on a daily basis.
“I’ve been to over 60 percent of the critical access hospitals, personally, in North Dakota to put a face on surgery because the Rural Surgery Support Program is an investment in giving back to the communities of not only Langdon but across the state from the Department of Surgery at UND,” Dr. Aaland shared.
The American College of Surgeons stated that 65 percent of general surgeries can be done as an outpatient surgery, meaning that those receiving surgery will not require an extensive stay and can leave and go about their lives with some restrictions, of course.
“This is music to the ears because technology and, specifically, anesthesia has been able to reach short-term effects so that way patients can go home the same day,” Dr. Aaland explained.
“This is no different than how the system, techniques, and technology have changed in farming. If you tried to farm the same as you did 30 years ago, you wouldn’t be farming,” Dr. Aaland added.
With so many surgeries now able to be performed on an outpatient basis, Dr. Aaland, through the effort of the program, is trying to take those 65 percent of surgeries and do them locally. There are those surgeries that still need to be done with the higher care which requires them to be done at larger facilities.
“The goal is to provide surgical referral and, in some cases, surgery. Not all surgeries, certainly not complex surgery, is possible at these locations, but we can find out what the communities need, specifically, then moving forward to the point where can we establish outpatient surgeries within the regions of the state,” Dr. Aaland said.
Hettinger was the first community that had this program implemented. Now the program has expanded to Tioga, Watford City, Devils Lake, Jamestown, Rugby, Linton, and now Langdon. Dr. Aaland is communicating with other locations ,but due to so much interest in the program, she is unable to get to them at this time. Strategically, Dr. Aaland believes that no one should be more than 50 miles from a surgical evaluation.
“When I look to the future, the sky’s the limit with what we can do once we get the technology in place,” Dr. Aaland shared.
This program is in its third year of reaching out to critical access hospitals such as Langdon and enhancing the rural medical facilities of the state with surgical referral and services. Dr. Aaland initially drove to community hospitals and visited with them to determine if the program was needed and could be possibly implemented.
“We need strong outpatient surgery centers, and when you can provide that, think about the possibilities of specialist surgeries. All of these critical access hospitals used to offer surgery, and we have forgotten that a general surgeon is part of a primary care team,” Dr. Aaland said.
Part of the program includes working together with other communities and health facilities for the good of the towns and regions. This partnership brings the best medical advice and services and is important to make the program a success. By working with innovators and staff within the hospitals, this will build the program to work within the region.
“One community and one region at a time is our approach to solve the surgical void in rural North Dakota,” Dr. Aaland said.
By looking at this need from a regional perspective of how services are provide that are both cost effective and best for the patient, the program will be able to tailor a surgical plan for each patient. Dr. Aaland notes that while one patient may be able to have an outpatient surgery locally, another patient may have too many factors or complication for that same or similar surgery that would require the patient to go to a larger facility for the care they need.
“We are going to use the resources here to the max, but some will still have to be sent to another facility,” Dr. Aaland said.
“The healthcare dollar is limited, and we have to start maximizing it using innovative means. This is an investment in the rural communities for the future through UND,” Dr. Aaland added.
To build and establish the program within the hospitals is a three year process that starts out very conservatively. Before surgery can be offered, the first steps are giving the necessary screenings to determine what is needed. From there, Dr. Aaland works to get the care patients need. Dr. Aaland is not alone in this endeavor as she has two other surgeons assisting with the program along with the Department of Surgery at UND. Dr. Aaland herself handles the implementation of the program at every new location.
Another part of this is community outreach, from speaking to high schoolers about careers in medical fields to enlisting community leaders. For Dr. Aaland, stressing to the communities through outreach is one way to understand what area facilities can offer and how that can be expanded.
As CCMH looks to take part in the program, the expense of it is part local expense and partly funded by UND. It is a total cooperative effort to improve surgical delivery to the rural communities and regions like those of Langdon and Cavalier County. UND provides for all the expenses including medical malpractice and travel costs. CCMH will need to provide only the agreed upon fee and housing for the covering surgeon. The fees are generally 30 to 50 percent lower than commercial locum tenen agencies according to UND.
“Hopefully these programs, Rural Track Surgeons and Rural Surgery Support Program, will entice the young people to go to school and then come back to their communities,” Dr. Aaland stated.
Dr. Aaland starts out all of the programs in the facilities and works on the building of the program within the hospitals to determine how and what the hospital needs. Dr. Aaland has already spent some time at CCMH leading up to her official start date of the program.
“I’m very impressed with CCMH. There has obviously been an investment,” Dr. Aaland shared.
Dr. Aaland will be present at CCMH three times a week with her first official start date of July 25.