MCMC collaborates with OHSU
December 21, 2008
MCMC collaborates with OHSU
Orthopedics and cardiac care will launch cooperative care effort
By KATHY GRAY
of The Chronicle
A collaboration between Mid-Columbia Medical Center (MCMC) and Oregon Health and Science University will bring increased orthopedic and cardiac care to the Mid-Columbia.
Administrators from the two organizations announced the collaboration Friday to management staff at MCMC. The two specialties are areas the MCMC administration has identified where the local need is significantly underserved. Officials of both organizations are describing this as a historic moment, representing a shift in delivery of rural medical care. Collaborating with MCMC allows OHSU to serve its mission of helping improve access to additional medical services in rural communities throughout the state, says Dr. Mark O’Hollaren, OHSU’s director of clinical outreach.
“We realize there is a significant shortage of physicians in many areas of the state and that creates problems of access, especially for subspecialty care that most rural areas are not able to support fulltime,” O’Hollaren said.
Orthopedics first
OHSU will begin providing regular medical and surgical orthopedic coverage in The Dalles in February 2009. Then MCMC and the university will jointly bring a cardiologist to the area in summer 2009, the Mid-Columbia’s first fulltime heart specialist. The organizations started with orthopedics due to the immediate shortage of local care. “The impetus for us really started in earnest when we lost Dr. Schwartz in orthopedics,” said Duane Francis, president and CEO of MCMC.
“We went from two orthopedists to one. Orthopedists, in addition to some other specialties and sub specialties, are probably the most difficult to recruit in the country. We worked earnestly on our own to try to recruit a replacement for Dr. Schwartz.”
The collaboration allows MCMC to quickly bring in orthopedic care while a full-time physician is being recruited. Through the orthopedic arrangement with OHSU, a physician member of the university medical staff and teaching faculty will practice in The Dalles a portion of every week. That physician also will spend one weekend a month in The Dalles providing after-hours call coverage in support of existing orthopedic specialists.
OHSU will also provide coverage in orthopedic sub-specialty areas as needed, with expertise such as complex revision spine surgery and bone tumors.
The arrangement will help create a smooth transition from part-time to fulltime once an orthopedic physician and surgeon has been recruited to practice in The Dalles. That individual will live and practice in the Mid-Columbia area and spend one day per week at OHSU teaching medical students, working with colleagues and providing patient care.
Building support
OHSU specialists in orthopedics and cardiac care are working closely in developing the local programs, O’Hollaren said. “Dr. Jung Yoo [chief of orthopedics at the university] over the last six to eight months has gone from a concept of this kind of thing to having 13 orthopedists say they want to come up to The Dalles on rotation,” O’Hollaren said. “That’s a huge feat at an academic medical center.”
“At the first meeting, Dr. Yoo had nobody raise their hand,” noted Dr. William Hamilton, MCMC’s executive director of medical affairs.
Dr. Joaquin Cigarroa has drawn on experiences in a similar arrangement already in place between OHSU and St. John’s Medical Center in Longview, Wash., to begin developing the cardiac program based in The Dalles. Cigarroa is associate professor of medicine, associate chief of clinical affairs for the OHSU division of cardiovascular medicine, and director of the cardiac catheterization laboratory.
How the MCMC collaboration takes shape remains to be seen, O’Hollaren noted. Cigarroa will be meeting with physicians in The Dalles to sound out their goals and expectations of a cardiac program.
“He really wants to listen to the doctors,” O’Hollaren said.
The St. John’s collaboration offers an illustration of how such partnerships help get treatment to rural patients within the critical time window for care.
A patient recently walked into St. John’s ER with chest pain. Doctors diagnosed a particularly serious type of heart attack and activated the special protocol designed to treat it. From the time the patient walked in at St. John’s to the time the coronary artery was opened with balloon angioplasty and a stent was placed to keep the vessel opened, 88 minutes had elapsed. The patient avoided major heart damage as a result of the quick treatment.
“The magic time is 90 minute for heart patients,” added Hamilton.
Programs such as Life Flight and MCMC’s recently implemented PACS digital imaging program are key services to help trim the number of minutes needed to reach care. They not only allow the patient to be transported more quickly, but also help offer the capacity for realtime consultations with OHSU’s specialists in Portland.
MCMC already has a track record with a similar form of collaboration, Francis noted. In the cancer care model used at the Celilo Center, Dr. Keith Stelzer, the medical director of the radiation oncology program, is part of a larger group of radiation oncologists out of the University of Washington.
“He regularly confers with and commiserates with others in his group,” Francis said. “He’s not our employee; he’s their partner. We, in essence, lease him.”
Stelzer lives in the community and is an active member of the local community, Francis added.
The collaboration with OHSU is a shift from the traditional model of tertiary hospital care, which was to move patients as quickly as possible to the central urban hospitals.
“OHSU’s goal here is to keep as much care as possible in the community,” O’Hollaren said. “That’s our number one goal.
‘‘When you look at OHSU, what’s it best at? It’s best at complex care,” he explained. “Our infrastructure is set up for complex cases. It’s hard in rural hospitals to have all that infrastructure. You have to provide the most care to the most people using resources most effectively. We are trying to augment that ability locally.”
When the patient’s health indicates a need to move from MCMC to OHSU, O’Hollaren says the goal is to provide “a seamless continuum of care.”
With the idea of keeping patients in the local area, MCMC and OHSU have already recruited a fulltime cardiology specialist, who will begin work in The Dalles this coming summer.
Dr. David Guarraia will move to the area after completing a cardiology fellowship at OHSU in July or August.
“Dr. Guarraia grew up in a smaller town and he wanted to practice in one,” O’Hollaren said. “He loves the Mid-Columbia area and is anxious to be part of the community.”
In addition to increasing care in underserved specialty areas, Francis also hopes the partnership with the academic hospital will serve as a pipeline for further recruiting of doctors to the Mid-Columbia. Residents from OHSU are already providing weekend coverage to help MCMC’s hospitalist program. Cardiac and orthopedic specialists will also be bringing residents to MCMC in conjunction with their local practices, exposing them to the local medical culture and practices.
Residents who spend time in rural areas — and those who grew up in rural communities — are more likely to set up practices in rural areas, Francis noted.
OHSU prizes medical students who are raised in rural areas,“ O’Hollaren added.
The ability to recruit new physicians in a variety of specialties is critical, Francis noted.
“I heard statistics just last week at a medical conference that we are retiring 32,000 physicians a year and graduating 8,000,” he said. “That’s a four-to-one differential.”
In addition, new physicians are no longer wanting to work the 12 or 16-hour days their Baby Boomer predecessors have, O’Hollaren said. Instead, they are looking for shorter days and a more balanced lifestyle, which means an even greater deficit in physician work hours — and a more critical physician need.
Francis was quick to point out that the agreements with OHSU are not in any way a merger or an acquisition.
“We think it is incredibly important to have dedicated men like Wally Wolf on our board to retain local autonomy.
‘‘OHSU is here at our invitation to help us expand access to care in comprehensive ways that would not have been feasible for us to pursue on our own. We anticipate a long and growing relationship with OHSU, but we will continue to move forward as a separate organization.”
Francis anticipates further advances as technology and partnerships come together.
“So many factors are coming together locally,” he said. “Life Flight is here. We have technology and telemedicine that allow consults in the Emergency Department. We are already seeing Life Flight transports into the hospital since Life Flight located here.”
MCMC can assess the situation to determine whether the patient needs further transfer or can be treated here.
Such transfers may mean getting care more quickly for patients in outlying communities around The Dalles.
“They may be able to get certain kinds of care quicker because we are closer, and they may not even have to go into Portland or major metropolitan areas,” Francis said. “Who knows? It’s a dream of stuff that may be coming about. There are all kinds of opportunities.”
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