By Robyn Baer, Fort Sill CannoneerNovember 13, 2008
It wasn't all that long ago that getting an appointment at Reynolds Army Community Hospital was a long shot. But Soldiers and their families no longer have to jump through hoops or wait for eons to get an appointment.
Reynolds administrators have been working long and hard over the past six months to recruit family doctors and specialists to meet Fort Sill's need for medical care. After all the hard work, the message now is "come on in."
In 2007 and most of 2008, Reynolds was short on primary care doctors and specialists. Doctors were taking on enormous numbers of patients, and Reynolds was referring many people to medical care in Lawton, Oklahoma City and Wichita Falls, Texas. In February, the hospital sent nearly 700 patients into the Lawton community to be seen. In May, Reynolds was short about 24 doctors.
To combat the crisis, the hospital has hired at least 14 primary care providers, to include physicians assistants, and the number of referrals is near zero, said John Schafer, Reynolds deputy commander for clinical operations.
"Unlike in May when you called us for an appointment and we'd say 'call back tomorrow' or we'd send you downtown for urgent care, we actually have appointments now," Schafer said. "Patients don't need to go to the emergency room and wait for hours to be seen. There are primary care appointments available now. ... We even have providers on the primary care side who have unfilled appointments at the end of the day, so we're looking for patients."
Hiring is not the only way hospital administrators freed up appointments. In November 2007, the hospital had around 33,000 patients, and now there are only about 29,000.
"We purposely have controlled our enrollment," Schafer said. "We've managed our enrolled population here, the demand, and increased the supply of doctors very purposely for two reasons: to make sure that those who are enrolled to us have access to our primary care, but also so when the (Base Realignment and Closure) population arrives, we're prepared."
The BRAC 2008 positions have been filled, and Reynolds is waiting on the funding for the BRAC 2009 positions, said Dr. (Lt. Col.) Bruce Lovins, chief of primary care at Reynolds. "There's actually still growth that's going to happen over the next year," he said.
New personnel at Reynolds include new primary care doctors, new pediatricians and new specialists.
"We've gone from one general surgeon for a long period of time last year to a total of four, three of which are actually boots on the ground, and we're projected to stay that way for quite some time," said Dr. Thomas Dykes, a urologist and the chief of surgery at Reynolds.
In orthopedics, the hospital went from having one PA and two orthopedic surgeons to three orthopedic surgeons and two orthopedic PAs. They've even been able to offer care to family members and retirees because of the increase, which hasn't happened in years.
In Optometry, patients are again able to self refer. They can get a consult to optometry or they can call for an appointment. That care is available for Soldiers, family members and retirees.
"We even have access in our surgical clinics so that if people are enrolled downtown, they are able to come back to Reynolds to receive their surgical care, especially in ear, nose and throat, general surgery and gynecology," Dykes said.
He said in most cases, elective surgery can be scheduled about 10 days from the initial visit. "Our wait list is not long," he said.
To cover down on open appointments, patients may begin receiving phone calls from nurses to schedule routine, annual appointments for things like mammograms and pap smears.
"We're actually trying to be a little proactive to go out and look at the community for some of the preventive measures that in the past may have been more difficult to get," Lovins said. Newly enrolled patients may also get calls to make an appointment for their initial screening by their primary care physician.
"We're really trying hard to make opportunities for patients to see their doctor when they want to," Schaefer said. "So we've driven down the burden on each provider, hired more providers and spread out the patients."
Additional measures have been taken to make it easier for patients to make appointments.
"We've put a lot of energy in our phone system to make sure it's answered in a timely manner and that patients aren't put on hold. Our wait time is down to less than 90 seconds before somebody talks to you if you're placed on hold, coming down from about 12 minutes a year ago," Schafer explained.
And then some
Before the influx of additional care providers, patients had difficulty getting appointments through TRICARE Online. Schaefer encouraged patients to start using it again to make appointments.
"You can call our appointment line starting at 7 a.m., and someone is going to answer the phone quickly and give you an appointment, but if you don't want to get up at 7 a.m., at 7 p.m. the night before, you can book your own appointment through TRICARE Online," Schaefer said.
Reynolds administrators said they know preparation for the influx of BRAC Soldiers and family members is essential. After the beginning of the new year Reynolds will release the hiring actions for 2009 BRAC positions.
That'll be our challenge to fill those," Schafer said. "Hopefully we'll hit the marks as well as we did last year because the BRAC population will arrive soon. We've had a bit of luck and have recently been quite successful in recruiting family physicians, but the difficulty is recruiting internists and pediatricians."
That difficulty is not specific to Fort Sill, but to all of Southwest Oklahoma and the Midwest in general, Dykes said.