title: Providing Cardiology Care in Rural Areas Through Visiting Consultant Clinics.
abstract: Workforce experts predict a future shortage of cardiologists that is expected to impact rural areas more severely than urban areas. However, there is little research on how rural patients are currently served through clinical outreach. This study examines the impact of cardiology outreach in Iowa, a state with a large rural population, on participating cardiologists and on patient access.
  
  
  
  Outreach clinics are tracked annually in the Office of Statewide Clinical Education Programs Visiting Medical Consultant Database (University of Iowa Carver College of Medicine). Data from 2014 were analyzed. In 2014, an estimated 5460 visiting consultant clinic days were provided in 96 predominantly rural cities by 167 cardiologists from Iowa and adjoining states. Forty-five percent of Iowa cardiologists participated in rural outreach. Visiting cardiologists from Iowa and adjoining states drive an estimated 45 000 miles per month. Because of monthly outreach clinics, the average driving time to the nearest cardiologist falls from 42.2±20.0 to 14.7±11.0 minutes for rural Iowans. Cardiology outreach improves geographic access to office-based cardiology care for more than 1 million Iowans out of a total population of 3 million. Direct travel costs and opportunity costs associated with physician travel are estimated to be more than $2.1 million per year.
  
  
  
  Cardiologists in Iowa and adjoining states have expanded access to office-based cardiology care from 18 to 89 of the 99 counties in Iowa. In these 71 counties without a full-time cardiologist, visiting consultant clinics can accommodate more than 50% of office visits in the patients' home county.
authors.affiliation: Tippie College of Business, University of Iowa, Iowa City, IA 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, NY.
authors.forename: Tae-Hyung
authors.initials: TH
authors.lastname: Pyo
authors.affiliation: Office of Statewide Clinical Education Programs, Carver College of Medicine, University of Iowa, Iowa City, IA.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Nelson
mesh_terms: D002309:Cardiology / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D006297:Health Services Accessibility; D006801:Humans; D007484:Iowa; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D014195:Travel / Q000191:economics
keywords: access to care; cardiology; geographic variation; rural outreach; workforce