Historically, neurosurgical care has existed in 3 locations in our region. A 100 bed hospital with 2 surgeons, a 250 bed hospital with 2 surgeons plus locum coverage and a 700 bed hospital with 8 surgeons. The two smaller hospitals are 50 miles apart, the larger hospital is 150 miles from the two smaller ones. The 250 bed hospital has no additional OR capacity. There is existing capacity at the 100 bed hospital. The surgeons at the smaller hospital have both recently departed.
Care at the 100 bed hospital has typically been spine surgery with some management of head trauma. In winter, transfer out from this hospital can be difficult due to fog impairing air transport and road conditions impairing ground transport.
Care at the 250 bed hospital includes spine, trauma and some brain tumor work. They provide 24/7 coverage but some shifts are covered by temporary physicians (locums). Physician relations between this facility and the smaller hospital have historically been tense and somewhat inflexible.
The largest hospital covers the full range of neurosurgery. It is the regional trauma center. All 8 physicians have busy practices with minimal time to consider travel to or support of the two smaller hospitals. They are open to helping to recruit and support associates in either of the smaller hospitals.
With departure of the two surgeons at the smaller hospital, we are considering how best to provide coverage. Close the program? Cover the facility from one of the larger hospitals? Place a surgeon supported by one of the larger programs at the smaller hospital? Other option?