It’s not every doctor who can remove your appendix, take out your tonsils and do your emergency C-section. But that’s what general surgery is all about. Isolated communities face a critical shortage of these broadly-skilled physicians. Restoring their ranks won’t be easy.
Few docs have what it takes to make it as a rural surgeon. In Part I of a three-part series on rural health care, correspondent Elizabeth Wynne Johnson takes us to a remote swath of north-central Idaho, to meet one
of the best.
Andrew Jones: "I’m Dr. Andy Jones. Family doc out here in Cottonwood, Idaho. We call it the Mayo Clinic of the Inland NW, St Maries Clinic."
If Andrew Jones were a cartoon character, he’d be the Tasmanian Devil. Some of the nurses even call him that. When he’s not in surgery, he’s seeing patients at the clinics.
Opening Door "Marlene? So how are you?"
...Or calling them...
Dialing, "Brenda! This is Jones. Your dang hair’s falling out?"
For almost 20 years, Dr. Jones has taken care of the people of Cottonwood. A town of 900 on a plateau flanked by the Salmon and Clearwater Rivers and the Rocky Mountains.
Andrew Jones: "I mean, it’s the largest or maybe the 2nd or 3rd largest county in the Unites States. And there’s one stoplight. So if that tells you anything. Pretty dang rural."
Jones is board-certified to perform general surgery. That makes him exactly the sort of doctor that rural communities and hospitals can’t live without. Literally.
It’s an increasingly rare breed of doctor. The state of Idaho has fewer than four general surgeons per 100,000 people. That’s overall. The number’s even lower in remote areas.
Amel Zumwalt is losing a piece of himself today. Nerve damage has caused his middle finger to curl permanently, leaving him with a hook he’s eager to be rid of.
In a matter of minutes, he gets his wish. Dr. Jones amputates the finger while Amel looks on.
Andrew Jones: "All right. I’m going to get you some pain medicine… ‘cause when that numbing wears off, it’s gonna hurt."
Amel Zumwalt: "Will that stuff in the 140-proof bottle, will that help me?"
Andrew Jones: "Amel, Amel, Amel, you are a character..."
Amel Zumwalt: "That’s the only one I’d let do it, this guy here. If I need surgery I want him to do it."
Doctor Jones has a lot of patients like Amel.
Andrew Jones: "A lot of the old farts in our community are not going to want to go 100 miles to see a doctor. And a lot of them are, you know, they’re suspicious of doctors. But if they, you know, see one in the Keuterville bar that’s having a 'brewski' with them, they’re more likely to come in and have preventative procedures done, like a prostate exam."
Not everyone thinks that a broad surgical practice is in the best interests of the patient. Or that doctors like Jones should do the range of procedures he does.
The American Society for Gastrointestinal Endoscopy has stated that only specialists should do colonoscopy.
Andrew Jones: "I don’t think so. If only gastroenterologists did colonoscopy, probably the majority of rural America wouldn’t get that procedure done. And same with a lot of surgeries in rural America."
PA: "Dr. Jones…please call 3-1-0"
Nationwide, more than 50-percent of general surgeons are over the age of fifty. So a wave of retirements is coming.
St Mary’s Hospital CEO Casey Meza doesn’t like to think about the day that Dr. Jones retires. But she knows it has to come eventually.
Casey Meza: "Family practice docs are not being trained to do the things that Dr Jones is trained to do. It no longer exists that a family practice resident is being trained to do an appendectomy or to take out a gall bladder."
Even so-called general surgeons aren’t as general as they used to be. Meza says they aren’t equipped to take the place of a Dr. Jones.
Casey Meza: "When we go to the market and start looking for a general surgeon to move to a rural area, we meet several surgeons who are very specifically geared toward women’s health or abdominal work or orthopedic work. But it’s very unique and very unusual to find a general surgeon these days who’s not only comfortable with doing every level of surgery, but then comfortable with coming in to a rural setting and being the only resource in town."
She’s wondering where that leaves patients like Amel. But her concern goes further.
Unlike many rural hospitals, St Mary’s in Cottonwood is financially solid. That’s largely thanks to revenue from
general surgical procedures. Keeping that capability in house is the only sustainable way for rural hospitals to keep emergency room doors open and ready for the next critical trauma.
Casey Meza: "Without one you don’t have the other"
Medical training programs in the Northwest have begun to take notice of the looming crisis. In 2002 Oregon Health and Science University launched the first-ever Rural Surgery Residency.
More recently, the Center for Rural Surgery in upstate New York created a fellowship specifically for general surgeons. The first fellowship recipient was in Bend, Oregon.
Door opens, Andrew Jones: "Chuck Finney you son of sea horse! See I told’ya...."
Today, Jones checks on his favorite ornery farmer whose hernia finally blew.
Andrew Jones: "You knew I was going to say I told you so!"
Chuck Finney: "No no no...."
Andrew Jones: "Yeah I told you so, you ol’ fart. Here, let me have you lay down here so I can look at that incision. It’s better to do it kind of electively"
Chuck Finney: "I did."
Andrew Jones: "No you didn’t! You came in here with one foot on a banana peel and the other in the grave!"
This day will end like most. It’s after five. The other hospital offices are empty. Dr. Jones has just sat down to yet another stack of charts.
Sherry: "Is there anything else I can do?"
Andrew Jones: "No, Sherry, go home. Go home and beat your kids...."
Sherry: "G’night Dr. Jones"
Andrew Jones: "Night Sherry, thanks...."
And it’s right back to dictation....
Phone rings: "Hello... Oh, thanks... I’ll be over to see those ERs in a minute"
Andrew Jones: "Let’s go see some patients ‘cause we’ll be in trouble if we don’t"