On the Road with Surgical Institute: SI Surgeons Meet Critical Rural Needs

By Kim Lee

In today's healthcare environment - with demand rising and the workforce shrinking - it's harder than ever to find timely access to quality care. But the challenge is often even greater for residents of our many rural communities, officially defined as towns of fewer than 2,500 people. 

But access for these residents is critical, not only for preserving their health, but for the ongoing health and economic stability of their communities. Unfortunately, the logistics of trying to ensure adequate access for these residents can be formidable. 

Enter Surgical Institute of South Dakota, PC, an independent Sioux Falls-based team of board-certified general surgeons. In addition to being on staff at Avera McKennan Hospital & University Medical Center, Sioux Falls Specialty Hospital, Avera Heart Hospital of South Dakota, and Sanford USD Medical Center, SI surgeons have also spent decades serving small, outlying hospitals and clinics. Today, those include Flandreau, Dell Rapids, and Freeman, South Dakota, and Hendricks and Tyler, Minnesota. 

But SI doctors are doing more than just providing easier access to needed procedures in these towns; their broad knowledge base allows them to play a crucial role in rural health. Their presence decreases the need for patients to travel for routine surgery, but it also provides backup for rural primary care providers and contributes to the overall financial health of rural hospitals.

David Strand, MD, a 27-year veteran of SI, provides surgery and procedures on an outpatient basis at the Avera Medical Group Dell Rapids clinic and Avera Dells Area Hospital, a 23-bed critical access hospital 22 miles north of Sioux Falls. Dr. Strand offers general surgical procedures like hernias, cyst removal, laparoscopic colectomies, catheter placement and removal, hemorrhoid banding, lipomas, colonoscopies and diagnostic procedures. He’ll also do follow-up appointments for procedures done in Sioux Falls by his partners.

“On any given day, Dr. Strand does 5-8 procedures and sees 8-10 clinic patients,” says patient care services director Karla Carstensen. Carstensen has worked with Dr. Strand for 20 of the 25 years he has served this small community. "He is extremely busy," she says.

“One of the problems we’re seeing is that specialists don’t always like to go to smaller communities, which leaves those areas with a lack of medical care,” says Dr. Strand. “We’re able to provide access to those communities and keep those patients there, which supports their staff and their hospital.” 

“I can’t begin to say how convenient these services are for our facility,” says Carstensen. “It’s a huge benefit to our patients to stay local. Our patients think it’s great. Dell Rapids is a growing community with a lot of young families as well as an older population that is well-established. They absolutely love that they don’t have to drive anywhere for these services.”

Flandreau, South Dakota is another community that benefits from SI’s outreach efforts. For two decades now, SI surgeon Donald Wingert, MD, has been offering services and procedures in Flandreau that would otherwise require patients to travel to Sioux Falls or further. “Procedures done at those hospitals are primarily endoscopies and colonoscopies and treating hernias, gall bladders and small skin lesions,” says Dr. Wingert. “I also see new patients who will need to be referred to Sioux Falls for other procedures.” 

Dr. Wingert has been with Surgical Institute since the start of his medical career in 1988. In 1994, he began outreach services in Flandreau, north of Sioux Falls, at its clinic and 18-bed critical access hospital,  Avera Flandreau Hospital. Now semi-retired, Dr. Wingert sees patients twice a month and performs procedures in its operating room. He does the same at Hendricks Community Hospital in Minnesota.

“Working in rural medicine, it’s not always easy to provide all the services our community needs," says Heather Hubbell, director of patient care at Avera Flandreau Hospital. "We have a lot of elderly patients, and Dr. Wingert’s visits prevent them from having to travel. It also gives our providers a chance to collaborate on patient care plans with him. They work closely with Dr. Wingert and he will refer to other specialists if he can’t provide the service they need."

Beyond meeting medical needs, Hubbell says Dr. Wingert’s bimonthly visits are also a comfort for Flandreau area patients.  “It’s a significant benefit for us,” she says. “He’s a very well trusted and known surgeon in our community, as he’s been coming here for more than 20 years.”

A Win-Win Arrangement

The communities and their residents are not the only ones who benefit from these regular road trips. The relationships established by spending time in a rural healthcare setting are fulfilling to the physicians, as well. “It’s nice to get away, to go to a smaller operation," says Dr. Strand. "I’ve done this long enough that I have relationships with a lot of patients in Dell Rapids.” 

It’s a similar situation for Dr. Wingert. He worked with SI in Sioux Falls for 28 years before deciding he’d prefer a less hectic pace. 

“About five years ago, I retired from a more active role in Sioux Falls because I was ready to slow down,” says Wingert. “I chose to continue to go to both Hendricks and Flandreau because I enjoy it so much. The people I work with and treat there appreciate the care.” 

“The service he provides is so very important to our community and he is someone whom so many know and trust, people feel comfortable getting the care they need,” Hubbell agrees. 

Surgical Institute’s outreach physicians not only help keep rural residents from having to delay needed care but, when necessary, they also provide trauma care and coordination with EMS teams and other health staff - all integral parts of a successful community health system. 

“Dr. Strand works well with our staff, and he’ll also bring medical students with him on occasion," sasy Carstensen. "He’s a wonderful educator, he loves to teach as he goes, every minute of it. He is passionate about what he does and that’s evident. He’s overall a great partner for our facility, with a good relationship with our own health professionals. It’s a very collaborative and collegial atmosphere.”

Other SI surgeons providing outreach services include Michael Bauer, MD, who services Freeman Regional Health Services, and Michael Person, MD, who works at Avera Medical Group Family Health Center in Sioux Falls each Thursday.