Itinerant surgical and medical specialist care in Kansas: Report of a survey of rural hospital administrators

In most rural areas, specialist nonprimary care, when available, is provide d by "itinerant" physicians and surgeons who periodically visit from a dist ant home base. Little is known about current usage and acceptability of iti nerant specialists in rural communities. Administrators of hospitals in rur al and frontier Kansas counties were asked to report the frequency of itine rant care in their facilities, the home base of each specialist and a listi ng of procedures performed during specialist visits. Administrators were al so asked to respond on a Likert scale to six questions inviting their asses sment of itinerant care. Responses were received from 53 of 56 hospitals. A ll offered at least one monthly session of itinerant medical or surgical ca re. The most common specialties represented were cardiology (in 87 percent of hospitals), urology (68 percent), orthopedics (68 percent) and radiology (60 percent). General surgeons consulted in over 80 percent of responding hospitals. Psychiatrists, dermatologists and neurologists were rarely avail able in the hospitals surveyed. Administrators generally rated itinerant ca re highly, though sonic expressed concern about revenue lost when specialis ts performed procedures in their home-base office or hospital. No associati ons were found between amount of care offered and potential explanatory var iables such as hospital size, distance from subregional centers, or percent age of patients hospitalized locally. Further study is needed to better und erstand differences in itinerant specialist utilization and acceptance amon g rural Kansas hospitals. Because Kansas demographics are similar to those of many other American rural areas, such study may offer insights applicabl e to other regions.