General surgery contributes to the financial health of rural hospitals and communities.

Rural hospitals and communities often profit from the ability to provide surgical services. There can also be substantial financial costs for individuals, hospitals, and communities associated with not having access to surgical care in rural areas. Despite these advantages, limitations that include a shortage of rural general surgeons and other surgical staff and financial constraints prevent some rural institutions from offering surgical services.

Bassett healthcare rural surgery experience.

The surgical training at Bassett is naturally broader than in many university settings, with a survey showing that nearly 70% of graduates who practice general surgery remain in a rurally designated area. Rural surgery experience falls into 3 categories: undergraduate, graduate, and postgraduate. The general surgery training program has no competing fellowships or subspecialty residencies; residents get significant experience with endoscopy; ear, nose, and throat; plastic and hand surgery; and obstetrics and gynecology.

Rural surgery: framing the issues.

Many rural residents have limited access to surgical care. Although this problem has been ongoing for the past few decades, several factors threaten to exacerbate the situation. The narrowing of general surgery practice, workforce shortages and inappropriate distribution of surgeons, changes in how surgeons are trained, and increasing health care costs contribute to the problem.

Are general surgery residency programs likely to prepare future rural surgeons?

Background: Too few surgeons practice in small rural areas of the United States. Many newly graduating surgeons choose not to practice rurally because they feel unprepared for rural practice. Family medicine residencies have a track record of placing graduates in rural settings.

Use of locum tenens surgeons to provide surgical care in small rural hospitals.

Background: Too few general surgeons practice in rural American communities, and many hospitals in the smallest rural areas do not have a surgeon. Therefore, it is likely that some small rural hospitals are using alternative arrangements to provide surgical care, including hiring locum tenens surgeons. We describe the degree to which small rural hospitals are using locum tenens surgeons to provide surgical services.

How does degree of rurality impact the provision of surgical services at rural hospitals?

Context: Rural residents frequently have decreased access to surgical services. Consequences of this situation include increased travel time and financial costs for patients. There are also economic implications for hospitals as they may lose revenue when patients leave the area in order to obtain surgical services.

General surgery at rural hospitals: a national survey of rural hospital administrators.

Background: Many rural residents have limited access to surgical care. Rural hospitals frequently struggle to provide surgical services due to workforce shortages and financial constraints. The purpose of this study is to describe rural hospital administrators' perceptions regarding the state of their general surgery programs and the impact that providing surgical services has on their hospitals' financial viability.

Rural versus non-rural differences in surgeon performed endoscopy: results of a national survey.

The ongoing decline in the number of general surgeons practicing in rural areas of the United States is concerning. Existing data show that rural surgeons perform a broad spectrum of cases including procedures that are not considered to be in the repertoire of most general surgeons. In particular, rural surgeons seem to be performing a sizeable number of endoscopic procedures.

Starting a general surgery program at a small rural critical access hospital: a case study from southeastern Oregon.

Context: Surgical services are frequently unavailable in rural American communities. Therefore, rural residents often must travel long distances to receive surgical care. Rural hospitals commonly have difficulty providing surgical services despite potential economic benefits.

Is a broadly based surgical residency program more likely to place graduates in rural practice?

Background: There is a shortage of general surgeons practicing in rural America. Rural surgical practices differ from those in urban settings encompassing a broader case mix with a larger percentage of time spent performing abdominal, alimentary, gynecological, genitourinary, and orthopedic procedures. Present graduates of many general surgical residencies do not obtain the range of experience necessary to practice effectively in this environment.

Small rural hospitals and high-risk operations: how would regionalization affect surgical volume and hospital revenue?

Background: Because higher hospital procedure volume is associated with better outcomes for many high-risk procedures, regionalization to higher-volume hospitals has been proposed as a way to improve quality of surgical care. The potential impact of such policies on small rural hospital volume and revenue is unknown.

Study Design: We identified all hospitalizations in small rural hospitals (less than 50 beds) in New York State from 1998 to 2001 that included an ICD-9 procedure code for 1 of 9 procedures for which there is a documented volume-outcomes association: abdominal aortic aneurysm repair, aortic-valve replacement, carotid endarterectomy, colectomy, coronary artery bypass, cystectomy, esophagectomy, pancreatectomy, or pulmonary resection.

General surgery programs in small rural New York State hospitals: a pilot survey of hospital administrators.

Context: Hospitals play a central role in small rural communities and are frequently one of the major contributors to the local economy. Surgical services often account for a substantial proportion of hospital revenues. The current shortage of general surgeons practicing in rural communities may further threaten the financial viability of rural hospitals and communities.

Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements.

Background: The purpose of this study is to determine the differences between rural and urban surgeons with regard to practice patterns, factors in choosing a practice location, and educational needs.

Study Design: A list of surgeons obtained from the American Medical Association was examined using the Office of Management and Budget definition of rural. Seventeen hundred rural surgeons were mailed surveys; 421 responded.