I grew up in Small Town, USA – a proverbial Midwest town located in mid-northern Michigan. Today, Kent City has a recorded population of just over 1,000 people. According to the US census bureau, it is quantified as a ‘village’ and has a total area of 1.34 square miles. When I lived there, we had one gas station, one grocery store, and one stoplight – a single blinking traffic signal in the center of our town. The local market was family owned, as was the hardware shop, the restaurant, and the pharmacy. When I shoveled my driveway in the winters, I wouldn’t dare hang it up when my portion of the road was clean; rather, I’d head over to the neighbors and shovel there too. Same went for mowing the lawn. If you mowed your lawn, without hesitation, you’d keep going until the neighbor’s lawn was mowed too. You’ve seen and read about places like these, and that’s where I come from – Kent City, Michigan is my roots.

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As for our healthcare, Dr. Edwards was the only physician in town and the closest major hospital was about a 40-minute drive into Grand Rapids. I vividly remember how big of a deal it was if somebody went to Dr. Edwards’ office only to be whisked off in a screaming ambulance or helicopter. Stories would quickly spread throughout the grocery store and gas station until the word made it all the way to the one stoplight. Quite literally, it was the talk of the town. The residents would sleeplessly worry until our neighbor, who was “sent to GR” or who got “transferred to the University of Michigan” in Ann Arbor, was safely back home.

This is why I’m passionate about equitable access to care for the rural health communities scattered throughout our country. We didn’t have access to advanced care. We didn’t have trauma specialists or even a general surgeon. We had somebody to go see when we had the flu or a sprained ankle. Outside of that, we heavily relied on the larger inner-city hospitals to have efficient processes to get our loved ones the care they needed at the time they needed it most. Without those major hospitals, we only had Dr. Edwards.

Today, I live in the 5th most populated city in the country. My son’s graduating high school class will have more graduates than Kent City had residents. It’s mind-blowing. Back in 2017 and while living in this massive metropolitan capital, I led the transfer center for one of the nation’s largest hospital systems and found myself on the receiving end of my old neighbors. I was, and am, helping my own. From my background growing up and entering the healthcare industry, I’ve learned that these rural hospitals must be good at what they do, but they must be even better at what they don’t do. They must have strong relationships and partnerships with healthcare providers and facilities that can give the higher level of care services that patients so often require. Here’s a hard reality – 87% of the time a transfer is requested, it’s for a higher level of care or a service not provided at the referring facility. That means that 87% of the time, the sending facility doesn’t have the provider specialty available (such as cardiology), or the level of expertise needed (such as ICU).

When these patients present to the ED of a hospital that doesn’t have these services, those healthcare workers simply, and bluntly, cannot care for them. They can provide some level of care, but if that patient deteriorates, the physician can do nothing but watch it happen. Furthermore, that lone physician working in this rural setting is typically the ED provider, the hospitalist, and the specialist, and when they need to transfer a patient, moving them out becomes a true ‘fire drill’. The phone calls start to multiple transfer centers. They talk to numerous intake agents, potential accepting hospitalists and intensivists, and hopefully they can bypass also speaking to the specialists. They often do this repeatedly to find out that they are on a wait list, or that the physician on the other end of the phone doesn’t agree with the need for transfer, or insert another reason here from the dreaded list of why a patient doesn’t move. This administrative burden is not small, and this is on top of the clinical burden of caring for a patient for which they were never trained to do. This is a dire situation but unfortunately, one that happens too often.

Now, looking at the larger facilities that can typically accept these transfer patients, they are more financially and operationally strapped than ever before (thanks, COVID). They are turning inward in panic and only caring for their own. It’s a valid argument – how are they supposed to accept transfer patients from other communities when their own emergency departments are overflowing with patient admissions? Staffing levels are at a critical shortage, beds are closed due to a lack of providers, and through all of this, the small rural communities are forgotten. We must think differently. We must refine processes, staffing models, IT infrastructure, etc. to meet the sudden new environment that is our healthcare industry. It will take time, tenacity, and resilience, and I know none of this is easy, but it is achievable. It’s a difficult puzzle to put together but the right data connected to the right processes and operations can and will make a significant difference, not just for the major healthcare systems, but also for the rural communities and the Dr. Edwards that they serve.

This is why I do what I do.

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