The Challenges of Rural ENT Practice

Four years ago, Martin S. Trott, MD, was burned out on otolaryngology. He was managing partner of a large, private northeast Ohio ENT/allergy and immunology practice. He worked 80, sometimes 90, hours a week. He could perform 900 surgeries a year.

Then Dr. Trott made the decision to move to Jackson Hole, Wyo., a rural resort town 20 minutes from the Idaho border, to live a better life. He took a job as director of the Ear, Nose, Throat and Allergy Clinic at St. John’s Medical Center. Two months in, he added vice chief of staff to his CV. Now he’s landed a teaching position.

Professionally speaking, though, he simply traded in Cleveland Clinic-sized problems for the challenges of rural medicine—issues such as weather, travel and transportation challenges; roadblocks such as the implementation of wide-ranging reforms that revamp everything from coding to clinical care to computers; and, perhaps most vexing, lack of time for patient care, training, sick days and—dare it be said—personal time.

Rural physicians face a variety of challenges that their more urbanized counterparts rarely see. But with proper planning and recognition of the obstacles, most physicians easily overcome them, said Brock Slabach, MPH, senior vice president for member services at the National Rural Health Association and former rural hospital administrator at Field Community Memorial Hospital in Centreville, Miss. “I’ve seen some brilliant work being done in rural communities using meager resources and being creative and thinking outside the box in terms of how they address problems,” he said.

Isolation and Infrastructure

Isolation can be difficult to adjust to for rural otolaryngologists hundreds of miles from the nearest tertiary care center, Dr. Trott said. “I think that the biggest challenge for someone who’s coming out of training and going to a rural location is [finding] someone to bounce ideas off of,” he added.

Dr. Trott finds counsel in his former colleagues. He’ll soon begin to serve as an adjunct assistant clinical professor of otolaryngology-head and neck surgery at the University of Utah in Salt Lake City, so he can reach out to physicians there when he needs a consult. He can and does refer cases there when circumstances warrant, and those otolaryngologists fill in for him with enough notice.

Sigsbee Duck, MD, who practices at Memorial Hospital of Sweetwater County in Rock Springs, Wyo., approximately 200 miles south of Jackson Hole near the Utah border, set up an affiliation with the University of Utah when he left private practice in 2009. He wanted to set up a support system with the ENT doctors he would likely be referring complicated cases to, and, in return, he opened a line of communication with them.