By Dan Surdam, MD

“Wyoming is known for its wide-open spaces, outdoor recreation, and people who have grit.”


March, 2017


However, living in Wyoming is not without its challenges, especially in accessing healthcare.

According to The Washington Times, June 6, 2015, “Wyoming ranks among the worst in the nation for deaths caused by suicide, accidents, the flu and chronic obstructive pulmonary disease. It also ranks near the bottom in the percentage of residents who have recently received a checkup.” According to this article, “poor health care coverage in rural areas and the state’s decision not to expand Medicaid are factors that contribute to those statistics.”

Dr. Surdam was born and raised in Laramie, Wyoming. He graduated from Colorado College in 1997 and Creighton Medical School in 2002. He completed his residency in Emergency Medicine at the University of Texas Southwestern at Parkland Hospital in Dallas, TX. He owns and operates two urgent cares (Stitches Acute Care) in Wyoming, and has a true desire to help Wyoming and its people gain better access to high quality, affordable healthcare.

Other barriers to health care access include our lack of health care providers, as the State traditionally has struggled recruiting providers to live and work locally. For physicians with a rural background who train to serve a rural population, Wyoming may seem like a perfect fit, yet high malpractice rates tend to drive away many of these candidates (J Rural Health. 2010 Summer;26(2):196-200).  Other contributing factors include a lack of amenities and difficultly with travel to other areas either by road or air, “Why Rural America Doesn’t Attract Doctors”, The Daily Briefing, (Sept. 12, 2014).

Whatever the cause, Wyoming has a “definite shortage” of physicians (Center for Workforce Studies Association of American Medical Colleges, Recent Studies and Reports on Physician Shortages in the US October 2012). How was this defined?

“More than two-thirds of Wyoming’s counties (15 out of 23) have fewer primary care providers than the national average, and 20 out of 23 Wyoming counties (87%) have fewer than the national average of primary care physicians per 100,000 population.”

The Wyoming Tribune Eagle pointed out that there are only a few reasons a physician will choose to come to Wyoming: family ties to the area; and or student loan repayment (Doctor Shortage Will Worsen, WTE, Dec 13, 2009). With the aging of many of Wyoming physicians, the shortage is only going to become worse.  The downturn of the state’s economy (Bloomberg View, Why Wyoming is in Economic Trouble, Dec. 19, 2016) will mean less money for student loan repayment and for those amenities that physicians and their families want and need in their communities.

Fortunately, times of crisis and economic downturns often lead to creativity.

I’d like to share a piece of innovation that is certain to change the landscape of health care in Wyoming: telemedicine.

Telemedicine has existed for more than a decade, yet its application has been disappointingly slow. Technology has now advanced to a point where telemedicine is easy and affordable.  For a state like Wyoming, telemedicine could be the answer to its ever increasing medical provider shortage, and a means to provide patients access to healthcare anytime, anywhere.

What is telemedicine? Put simply, it is a health care visit with a provider, outside of the traditional bricks and mortar clinic, over a HIPPA compliant, Skype/FaceTime type application visit using one’s computer, tablet or smart phone.  These virtual visits are real time, and the patient interacts directly with the healthcare provider using one of the above devices.

Many communities in Wyoming are separated by vast distances.  Many communities lack health care resources.  In communities with healthcare providers, often getting an appointment can be difficult.  The beauty of telemedicine in Wyoming is that patients can visit a provider virtually without having to drive long distances or wait in rooms full of sick people. If it is in the middle of the night and one is contemplating a drive to the ER, it could potentially save an ER visit and the substantial cost associated with the ER by being seen virtually.  After your visit, the provider is able to electronically send or call a prescription in to your local pharmacy.   How simple is telemedicine? The patient only needs a wi-fi/internet connection and a phone or computer with a camera.

The technology associated with telemedicine has traditionally been difficult to use and expensive.  But newer technology has made virtual visits accessible to both providers and patients alike.  Requirements for adopting this technology only include the need for wi-fi or internet access.

Telemedicine provides a different way to give and receive health care. Moreover, educating the community, patients, and potential patients about telemedicine is the single most difficult task of implementing this innovative model of health care delivery.

Of course, telemedicine won’t be for every diagnosis, but those conditions can be screened and triaged during a telemedicine visit.  If the patient has an urgent condition and needs to be seen physically by a provider, she or he will be instructed to do so.   The triage portion of telemedicine will be instrumental in decreasing unnecessary emergency department visits throughout the state, assuring patients receive the right care, at the right time, at the right place.

With the challenge of recruiting and retaining rural healthcare providers in Wyoming, innovations such as telemedicine offer our patients increased access to improved medical care.

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