Meeting increasing demands for rural general surgeons

Abstract

Dynamic assessment of the effective surgical workforce recommends 27,300 general surgeons in 2030; 2,525 more than are presently being trained. Rural shortages are already critical and there has been insufficient preparation for this need. A literature review of the factors influencing the choice of rural practice was performed. A systematic search was conducted of PubMed and the Web of Science to identify applicable studies in rural practice, surgical training, and rural general surgery. These articles were reviewed to identify the pertinent reports. The articles chosen for review are directed to four main objectives: 1) description of the challenges of rural practice, 2) factors associated with the choice of rural practice, 3) interventions to increase interest and preparation for rural practice, and 4) present successful rural surgical practice models. There is limited research on the factors influencing surgeons in the selection of rural surgery. The family practice literature suggests that physicians are primed for rural living through early experience, with reinforcement during medical school and residency, and retained through community involvement, and personal and professional satisfaction. However, more research into the factors drawing surgeons specifically to rural surgery, and keeping them in the community, is needed. A crease will, however, disproportionately affect the rural areas. Further, declining availability of general surgeons will have a devastating effect on hospitals in rural areas. A New York State survey of hospital administrators of small, rural hospitals reported that 40 per cent of the hospital margin depends on general surgical procedures. Eighty-seven per cent of these hospital administrators thought that the general surgeon was essential to the hospital’s financial viability, and 40 per cent said that the hospital would be forced to close if the surgical service was discontinued.2 The National Center for Rural Health Works has estimated that an average rural general surgeon generates $2.0 million of direct revenue (practice and hospital) and 19 jobs, with a community impact of $2.66 million and 26 jobs.5 The present medical education system and changes to graduate medical education will not be adequate to address the population requirements in the upcoming years. In addition, the urban-rural maldistribution of providers will worsen, resulting in delayed or nonexistent access to care in rural areas.6 Therefore, we performed a systematic review of the literature to identify effective practices promoting selection of a rural surgical career. This information can be used to design interventions throughout medical training to encourage the practice of general surgery, especially in the rural United States.