Strengthening Emergency Medicine for Rural Communities

Somewhere in rural America, a little girl falls on the school playground and breaks her arm. Her parents leave work to drive her to a small emergency department (ED) several towns away. The ED staff do what they can but admit they do not have the specialist expertise to set and mend her broken arm – she needs to transfer to a larger hospital, which is several hours away. After an ambulance ride and an overnight stay, the girl is on the road to recovery.

“But now that family is looking at travel expenses, more medical bills, missed work and school because they needed to visit another hospital,” says Ramsey Herrington, MD, University of Vermont Health Network chair of emergency medicine and a long-time ED physician in the health system. “Situations like this play out every day in rural America, especially now as more physicians and nurses retire or leave rural hospitals to work in urban hospitals with more opportunities." 

Across the country, fewer aspiring clinicians are choosing to practice in rural areas. In recent years, this worrying trend hit close to home. Not long ago, it wasn’t uncommon for UVM Health Network to have little to no physician candidates apply for open positions in the health system’s rural EDs. It was a problem in need of an innovative solution. 

“We recognized several years ago that we have to think differently about how we provide emergency medicine if we were going attract the expertise we need and ensure that high-quality emergency care is available close to home, regardless of where you live,” says Dr. Herrington. “Thinking of that girl with the broken arm, we aspired to a system where, regardless of the ED we’re talking about, we could get her treated and back to her normal life as soon as possible.” 

A New Approach to Rural Emergency Medicine 

Rural communities in Vermont and northern New York face many of the same health challenges common throughout rural America – patients are growing older, suffer from more chronic disease and struggle with unmet mental health needs. More than three quarters of Americans living in rural towns struggle to access adequate health care, and they are dying younger than their urban counterparts. 

“The challenges facing rural health care are daunting, and hospitals can’t fix them alone,” says Willie Baker, MD, an emergency medicine physician with UVM Health Network. “But across our health system, there’s a strong sense of responsibility to ensure our rural communities have an equal chance to live healthy lives and age with dignity.” 

Dr. Baker was part of the team of like-minded ED clinicians that partnered with Dr. Herrington to reimagine how UVM Health Network provides emergency care for rural communities. The new approach combines a unique staffing model with technology to provide more care locally. More local care means more equitable access to services and prevents unnecessary transfers, lowering the overall cost of care for patients and the health system and getting people back to their daily lives more quickly. 

Under this new model, every UVM Health Network ED physician is now assigned clinical responsibilities at two or more EDs. For example, a UVM Health Network ED physician may spend part of their week providing emergency care at Alice Hyde Medical Center in Malone, New York – a small critical access hospital – and the remainder of their time at UVM Medical Center, an academic medical center and the region’s only tertiary care hospital, building critical emergency care skills.

“Because our physicians regularly work in rural EDs, where immediate specialist support may be limited, they gain valuable experience honing their skills for infrequent, but time-sensitive emergencies like setting a broken arm, delivering a baby or placing a chest tube,” says Dr. Baker.

The end result, Dr. Baker says, is patients are less likely to encounter situations where ED staff lack the clinical skills and experience required to immediately provide the higher-level care they need.

Bringing More Expertise to the Bedside with Technology 

Meanwhile, UVM Health Network is using telemedicine technology that became commonplace during the pandemic to reshape how it provides emergency medical care. Telemedicine refers to digital tools that help clinicians remotely evaluate patients, share information or collaborate in patient care, among other things. All UVM Health Network EDs are now equipped to provide and receive support through this technology at each partner hospital, creating an immediate link between local staff and emergency specialists elsewhere in the health system. 

“By remotely linking our ED clinicians with their colleagues across our health system, we’re enabling our specialist physicians to support their peers during emergencies and elevate the care available at the bedside locally,” says Matt Siket, MD, a UVM Health Network ED physician who has helped to drive the health system’s adoption of new technologies in emergency medicine. “These capabilities have made it easier for our specialists to assist with emergencies at hospitals outside of our health system as well.” 

Telemedicine also allows UVM Health Network’s EDs to flex in real time to match capacity with patient care needs. For example, ED physicians can remotely triage patients at other, busier EDs, reducing wait times for care and improving the overall experience for patients and clinicians.

Transforming Recruitment in Emergency Medicine  

UVM Health Network’s approach to emergency medicine has significantly increased interest in opportunities within the health system’s EDs, drawing much-needed expertise to the region. 

While most of the country’s rural EDs struggle with an extreme shortage of experienced physicians and nurses, our health system’s emergency medicine workforce is growing. This year alone, UVM Health Network has had more than 70 applicants for roles in its EDs – many from physicians drawn to the health system because of the diversity of clinical experience on offer.

“The impact on patient care can be profound,” says Dr. Herrington, “On any given day, you can walk into one of our most rural EDs and find some of our most experienced and specialized emergency medicine providers – that’s not something you find very often around the country today.”