Bringing cardiac care to the heart of rural America

The medical care disparity is widening between urban and rural America. What can we do about it?

Every idea has an origin story and unfortunately ours is a sad one. It involves a beloved physician in rural South Dakota who needed a cardiac procedure. A team of nearby doctors flew in to treat him, but given the harsh weather, the helicopter crashed and all aboard perished.

As an interventional cardiologist with a thriving practice in DC, this story gutted me and I felt a strong pull to change the paradigm in that community and others like it.It was with this goal in mind that I began speaking with colleagues about how to provide critical help to communities in desperate need of cardiology services.

The stats are sobering. The life expectancy of people living in rural United States is declining. Rural based community hospitals are closing at higher rates than ever before. The medical care disparity is widening between urban and rural America. These facts are alarming. The medical literature is full of epidemiologic studies, database reviews, observations and alarming assessments, yet the issues persist and continue to worsen.

Here are some examples:

  • From 2013 to 2017, 64 rural hospitals have closed, a rate of closure double that of the previous five-year period. In the United States, the mean EMS response times for rural Zip Codes are nearly double that of urban Zip codes (health serv res. 2020; 55:288-300).
  • Rural disadvantage in life expectancy continues to grow (International Journal of Epidem, 2021, 1970-1978).
  • Between 1999 and 2017, rural areas exhibited greater cardiovascular disease age adjusted mortality among all subgroups, with the absolute difference between rural areas and large metropolitan areas nearly doubling over time (JAMA 2020 May 12; 323(18): 1852–1854).
  • Disheartening stats like this cause my colleagues and me great distress and drive our desire to be part of the solution.

Rural hospital closures are associated with long-term decreases of physician specialists like cardiologists. Even when the necessary facilities do exist, they are frequently understaffed and suffer from shortages of physicians able to care for cardiac patients. According to the latest data from the Health Resources and Services Administration in March 2020, nearly 70 percent of areas designated as having health professional shortages were rural or partially rural areas.

The answer is obvious, but also challenging: Ensure there are enough cardiologists in rural areas to keep cardiac units with Cath Labs up and running. The question is, given the flight of medical professionals from small and rural towns, and from the healthcare professional in general, how can we make these jobs appealing? I kept thinking there must be a win/win where both the communities and doctors are rewarded.

The logical conclusion was to create a new type of practice model, and thus, CardioSolution was born. The mission was to make life-saving treatment available in small town and rural hospitals by keeping cardiac units up and running and providing high quality patient care. Attract highly trained and accomplished interventional cardiologists through a competitive pay package that also provides tremendous work/life balance, something unheard of in our medical community.

The hospitals that contract with CardioSolution are provided with a two-person Interventional Cardiologist team, who in effect job share the role. Each doctor works for 7 days and then spends 7 days at home, with a four-hour handoff time between on and off weeks.

When they are working, they are living in that community and available 24/7 for any emergencies that arise. When they are off, they are with their families, doing school drop off, attending plays and enjoying time to pursue a hobby or just relax: again, something unheard of in our profession.

My colleague is a great example. Bradley A. Serwer, M.D. is an interventional cardiologist and former staff physician and served as the senior medical officer at the US Capitol from June 2004 -July 2007. He cared for members of the House of Representatives, Senate and Supreme Court. 

Today, he is working for CardioSolution at Wayne Memorial Hospital in Honesdale, Pennsylvania.

According to Serwer, “When I was in private practice in DC, half my day was spent driving from one hospital to another. I was working from 6 am – 7 pm every day and felt more and more disconnected from my patients and my family.”

CardioSolution presented him with an opportunity to apply his talents in a way that was less personally draining.

“Today I have the satisfaction of knowing I am keeping a cardiac unit open in a small hospital, giving life-saving treatment to dozens of patients where getting treatment in time is absolutely of the essence. At the same time, when I’m home, I’m available to my family in ways that were previously unimaginable.”

But of course, to make this program a reality, there must be a win for the hospital and the community and I’m glad to say there is.

The opportunity cost of not having a functional Cardiac Unit and Cath Lab is devastating to small communities, both from a health and financial point of view. With cardiac care, time is of the essence, so having to divert patients to nearby cities can have disastrous results. Furthermore, cardiac units are typically among the top generating units in a hospital. Losing or not having that unit is costly.

Towns in rural America revolve around their community hospital. The community hospital is a major source of employment. They provide prompt care locally without the need to travel to urban areas. These hospitals and their staff support the community fiscally, emotionally and medically. The community and their hospital are intertwined in a symbiotic relationship.

If these services are diminished due to lack of staff or economic insolvency, the community suffers.

By contrast, having a functioning hospital including a cardiac unit dramatically improves the communities’ health outcomes while maintaining the towns’ economic health and viability. Patients have better outcomes and enjoy the comfort of their families and loved ones when they are treated locally. Everyone benefits.

As I continue to lead the CardioSolution business, and also work as a cardiologist in a small Kentucky hospital, I reflect on the last decade with great pride for what we’ve all achieved together. In an age with so many healthcare issues to solve, it’s nice to have a win/win!

Lou Vadlamani, MD, FSCAI is an interventional cardiologist and the founder and CMO of CardioSolution, a physician-led group that brings heart care to underserved communities across the country. Vadlamani received his medical training at the University of Pennsylvania. He did his residency and fellowship in Cincinnati, an extra year of interventional fellowship in Boston, then joined the faculty at The Ohio State University. He wanted to sub-specialize in peripheral vascular interventions, and so did a committed fellowship with Bill Gray, M.D. in Seattle. He then practiced in Atlanta and in Virginia before deciding to provide services to smaller communities that had a significant need. This led to the creation of CS. He continues to see patients in a small Eastern Kentucky town.