title: Improving Rural Access to Orthopaedic Care Through Visiting Consultant Clinics.
abstract: BACKGROUND
  Patients from rural areas tend to be older and less physically active and are more likely to be obese, increasing their need for orthopaedic services. However, few orthopaedic surgeons practice in rural areas. One approach to meeting the needs of rural patients is visiting consultant clinics (VCCs). In this study, we examined orthopaedic surgery outreach in Iowa, a state with a large rural population. We assessed the involvement of the 2014 Iowa orthopaedic surgery workforce in outreach activities for the geographically disadvantaged rural population and its effect on patient travel distances.
  
  
  METHODS
  The University of Iowa Carver College of Medicine annually tracks VCC locations and frequencies. Data from 2014 were used to estimate average trip length for participating orthopaedic surgeons and patients in all Iowa census tracts. Primary practice locations, visiting consultant clinic locations, and census tracts were classified according to the 2010 Rural-Urban Commuting Areas (RUCA) classifications.
  
  
  RESULTS
  In 2014, 4,596 VCC days were provided in 80 predominantly rural sites. Overall, as a result of VCCs staffed by orthopaedic surgeons in Iowa and adjoining states, the number of Iowan counties with an orthopaedic surgeon increased from 35 (at his/her primary practice location) to 88 (at a VCC or primary practice location) of 99. Forty-five percent of all Iowa-based orthopaedic surgeons participated in a VCC. Visiting orthopaedic surgeons drove a total of 32,496 mi (52,297 km) per month to conduct these clinics. The average driving distance to the nearest orthopaedic surgeon was reduced from 19.2 mi (30.9 km) to 8.4 mi (13.5 km) for rural Iowans as a result of monthly VCCs. Monthly VCCs improved access to orthopaedic surgeons for between 450,000 and 670,000 Iowans from a total population of approximately 3 million.
  
  
  CONCLUSIONS
  VCCs staffed by orthopaedic surgeons from Iowa and surrounding states improve access to orthopaedic care by reducing driving distances for rural patients.
authors.affiliation: Tippie College of Business (T.S.G.) and Office of Statewide Clinical Education Programs, Carver College of Medicine (G.C.N.), University of Iowa, Iowa City, Iowa Thomas-gruca@uiowa.edu.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Gruca
authors.affiliation: School of Business, State University of New York, New Paltz, New York pyot@newpaltz.edu.
authors.forename: Tae-Hyung
authors.initials: TH
authors.lastname: Pyo
authors.affiliation: Tippie College of Business (T.S.G.) and Office of Statewide Clinical Education Programs, Carver College of Medicine (G.C.N.), University of Iowa, Iowa City, Iowa Gregory-nelson@iowa.uiowa.edu.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Nelson
mesh_terms: D003253:Consultants; D006297:Health Services Accessibility; D006801:Humans; D007484:Iowa; D009985:Orthopedics; D012017:Referral and Consultation; D012423:Rural Health; D012424:Rural Population; D013997:Time Factors