Perspectives on Healthcare - Spring 2010

May 1, 2010 Rod Hochman, MD

Welcome to the latest installment of Perspectives. Since we started this series 18 months ago, we’ve examined a number of issues that impact the future of health care. But one topic we have not yet addressed is the severe shortage of physicians in this country.

About 60 million Americans are affected by the shortage in that they live in one of 3,000 U.S. communities designated as medically underserved, meaning there are not enough doctors to meet the needs of the local population. Our state has a higher rate of physicians than most, but even still, there are 147 communities right here in Washington that carry the medically underserved designation.

The physician shortage dates back, largely, to the mid-1990s when experts predicted the country was headed for a surplus of physicians. As a result, medical schools froze enrollment and began graduating fewer and fewer doctors.

The shortage has been exacerbated by aging baby boomers, who require more medical attention as they grow older. And now that health-care reform has passed and 30 million more Americans will have access to health insurance, the demand for doctors will continue to outpace the supply – by a large margin.

Addressing the shortage

At Swedish, we’ve been tackling the issue on a number of fronts. Our medical home in Ballard is an innovative clinic designed to make the most of a limited supply of primary- care physicians while also delivering better, more accessible care to patients. The clinic encourages patients and physicians to communicate over the phone and via secure email, which can sometimes be a faster, more efficient use of time than in-person appointments. The clinic also takes a team approach to care that heavily involves other disciplines, such as nurse practitioners, R.N.s and social workers. Our medical home was the focus of an earlier edition of Perspectives.

In addition, we’re looking at ways to develop and train lay workers to serve as an extension of physicians by helping with education and prevention in underserved communities. This is a model that has been effective in global-health campaigns, and we believe there is an opportunity to also make it successful here at home. And, of course, we continue to invest in physician training and education through our residency programs in family medicine and general surgery.

Telemedicine: treating patients virtually

Another way we are addressing the physician shortage is through technology. Telemedicine makes it possible for physicians to examine and even treat patients remotely.

The field of stroke care is an example of how telemedicine is being used successfully.

As the third leading cause of death and a leading cause of disability, stroke is a serious health issue in this country. But it doesn’t have to be. The risk of both death and disability can be dramatically reduced if patients are diagnosed and treated appropriately within the first three to 4 1⁄2 hours that a stroke begins.
The problem is that most stroke victims do not get the intervention they need in a timely fashion. It’s partly because many Americans still don’t recognize the signs of stroke. But it’s also because there is a shortage of neurologists in this country. The United States only has four neurologists per 100,000 Americans despite nearly 800,000 cases of stroke per year. And many communities do not have a local hospital with neurological expertise.

To help fill this gap, Swedish has deployed a computerized image-sharing and video- conferencing network known as Telestroke. The technology allows neurologists and other members of the Swedish stroke team to virtually be present in rural or suburban hospitals whenever a potential stroke patient presents in the ER. The Swedish team works with the ER physician on duty to review imaging exams, discuss labs results, examine the patient and talk through treatment options.

The Swedish Telestroke network is helping to improve stroke outcomes in places like Mount Vernon, Port Townsend, Chelan and Wenatchee – all communities that would otherwise be underserved by neurological care.

From remote ICU monitoring to mobile mammography

Intensive care is another area where telemedicine is making a difference. Through our eICU monitoring system, physicians and nurses at Swedish help oversee critically ill patients at hospitals in outlying communities. The monitoring technology allows our specialists to remotely detect even the most subtle changes in a patient’s vital signs and alert hospital staff when something seems awry.

The service provides an extra set of eyes and ears to the staff in community hospitals 24 hours a day, seven days a week. It’s one way Swedish is helping outlying communities not only address the shortage of intensive-care physicians but also improve quality of care by sharing sophisticated monitoring technology.

Another vital form of telemedicine available through Swedish is the Swedish Breast Care Express. The mobile mammography coach travels throughout Western Washington – to places as remote as the Macah Indian Reservation on Neah Bay – to help ensure women in underserved communities receive annual breast screenings.

The breast exams are done on the coach, which is a fully equipped breast imaging mobile clinic. The imaging tests are then transmitted, via a secure network, to radiologists in Seattle who review the images and then report their findings back to the staff of the mobile clinic. For many women, the Breast Care Express is their only opportunity to access routine mammograms.

Telemedicine made possibly by philanthropy

By using technology to make our specialists accessible to people in medically underserved communities, we are making a difference and literally saving lives. None of this work would be possible without the generosity of private individuals, corporations and foundations in the Greater Seattle community. What’s even more special about our telemedicine activities is that they are almost entirely funded by philanthropy. The community has shown tremendous support by raising $1.3 million to support the Breast Care Express, $3.8 million for the eICU program and $400,000 for our Telestroke Program.

On behalf of everyone at Swedish, thank you for making it possible for us to create greater access to medical expertise and address the physician shortage in innovative ways that are both highly efficient and result in better outcomes for patients in rural and underserved areas. To learn more about how you can support or get involved in our telemedicine efforts, please contact Don Theophilus, Executive Director of the Swedish Foundation and VP of Development,, (206) 386-2819.

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