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Rural Surgery

Kandace Kichler, MD
Celeste Hollands, MD, FACS

Twenty-five percent of the US population lives in rural areas (an area with a populations served of less than 50,000), and currently only 10% of general surgeons serve these areas. Rural demographics include patients that have variable insurance coverage status, patients whom are less likely to seek medical care early, and patients who appreciate locally available medical care. There is no typical rural surgeon, however, currently most rural surgeons are males, greater than 50 years of age. Up to 1/3 of rural surgery practice is endoscopy, which most receive training for during their general surgery residency. Rural surgeons can have triple the number of cases of an urban general surgeon. Due to the historical lack of local subspecialties in rural settings, surgeons in rural settings are benefited by having a very diverse case mix. General surgeons are an asset to most rural hospitals, and their contributions have huge economic impacts on the community.

Challenges of rural surgery include payment policies linked to quality and volume expectations, decreased reimbursement, liability for performing procedures outside the scope of practice of a general surgeon, and the increased cost of certain services difficult to sustain in a lower volume setting. Professional isolation and frequent on-call responsibilities are other concerns that must be acknowledged when considering a career in rural surgery. Rural surgery may become less feasible in the future due to the growing litigious American society as well as the fact that younger surgeons may not feel comfortable performing procedures outside of their general surgical training. Without a general surgeon, a significant number of rural hospitals felt they would have to close their hospital.