In remote areas worldwide, the availability of trained medical personnel continues to be problematic, but new research shows that there are also shortages of healthcare providers in the United States. Recent reports indicate that approximately 65 million Americans live in federally-designated primary-care health-professional shortage areas (HPSAs), defined as regions with 2,000 or more residents per primary-care doctor. A recent study in the journal Academic Emergency Medicine found that three-quarters of U.S. emergency department directors indicated that they did not have adequate on-call trauma surgeon coverage. In addition to a lack of emergency department personnel, some regions of the U.S. are experiencing shortages of ophthalmologists, pediatricians, nurses, and dentists, all of which result in a lack of quality healthcare services. Treatment outcomes can be improved by finding alternative means of ensuring that patients have access to specialty healthcare.
Nearly a quarter of the U.S. hospital emergency departments that participated in a recent study reported an increase in the number of patients who left the facility before being seen by a specialist. According to the study’s lead author Dr. Mitesh Rao, 21 percent of emergency department deaths and permanent injury can be linked to shortages in specialty physician care. Further, more than 70 percent of participating emergency departments noted staff shortages in neurosurgery and hand surgery, and for patients with traumatic brain or hand injuries, the resulting delays in care could significantly increase the risk of lifetime disability, and according to Dr. Rao, the study’s lead author, “Transferring patients significant distances to an available specialist is sometimes the only option.”
In regions with a dearth of a particular type of medical professionals, availability of general treatment may also be significantly limited. Reports indicate that 14 of 81 counties in Kansas have no dentists, leaving residents with few options. Without appropriate dental care, patients’ risk of developing infections detrimental to the heart and lungs can increase, as can the risk of other conditions. Pediatricians and family care physicians are also lacking in some areas of the U.S. According to a recent study, nearly one million children live in areas with no local doctor. Nurses are also in short supply in many areas, and according to experts, by 2020 the nation will have 29 percent fewer nurses than are needed to provide care.
To ensure the provision of care to patients in areas that lack clinical staff, some experts suggest the use of telemedicine and remote screening programs. Through these programs, specialists can provide clinical advice to clinicians remotely and improve the level of care provided without requiring transport of the patient. Remote screening and diagnosis have been proven effective for diabetic retinopathy in areas where expert ophthalmologists are not available. Using a special camera, clinical staff and technicians captured a picture of a patient’s eye and send it to a trained professional. Eighty-three percent of individuals with retinopathy were diagnosed correctly using this remote screening technique regardless of the level of medical training of the individual taking the photograph. Teleradiology programs have also been implemented in some areas, a number of which are now utilizing fourth-generation wireless networks to allow radiologists to transfer images more and make preliminary evaluations more quickly.
Comprehensive telemedicine programs can help to ensure the delivery of specialty healthcare in underserved areas of the U.S. and worldwide. The iCons in Medicine program is an global telehealth and humanitarian medicine volunteer alliance that serves to connect volunteer healthcare providers with individuals and clinics requesting assistance on challenging cases. Membership in the iCons in Medicine network includes nearly 400 individuals in 12 countries around the world. These individuals represent 35 academic and medical centers, and include renowned experts in telemedicine, e-health, and global health disparities. Over 130 physicians with expertise in 35 medical specialties are available to respond to teleconsultation requests from individuals representing over 20 organizations in 10 countries. Through the use of telemedicine and remote diagnosis and screening programs, the delivery of specialty care in remote areas and treatment outcomes can be improved.