When is Rural not Rural: An Examination of the Provision of Surgical Services in Rural Hospitals

Background

There is limited access to surgical care in many rural areas. It is often difficult for rural hospitals to offer surgical services due to financial and workforce constraints. While there are clear differences between rural and urban hospitals, not every rural hospital is the same because rural communities differ in size and location. Hospitals located in different types of rural areas likely provide varied services, including surgical care, based on their community's degree of rurality. The purpose of this paper is to describe the differences between smaller and larger rural hospitals with regard to the provision of surgical care.

Data Sources and Study Design

A 12-item survey was mailed to a randomized sample of national rural hospital administrators (n=233). Rural hospitals were defined as those located in Rural Urban Commuting Area Codes (RUCA) greater than or equal to four. One hundred and eleven surveys were completed yielding a response rate of 48%. In addition to overall descriptive analyses, comparisons were made between hospitals located in smaller versus larger rural towns as well as those hospitals with and without critical access designation.

Key Findings

All large rural hospital administrators perceived their surgery programs to be very important to their hospitals' financial viability compared with 60% of very small and 75% of small rural hospital administrators. Very small and small rural hospitals have a median of 0 and 1 full-time surgeons respectively compared to nine at large rural hospitals. Almost half of the surgeons practicing at large rural hospitals are older than 50 years and are planning to leave their positions sooner than at smaller rural hospitals. More than half of large rural hospitals are currently recruiting a surgeon compared with a third of small rural hospitals and 12% of very small rural hospitals.

Conclusions

The results of this survey show that among rural hospitals of varying sizes there are significant differences in the types of surgical services offered and the financial importance placed on providing surgical care. These differences support the concept that not every rural area is the same in terms of needs for and provision of healthcare services. Small rural hospitals have workforce issues like those of very small rural hospitals, yet the importance they place on being able to provide surgical care is similar to that of large rural hospitals. Policy efforts should be aimed at addressing workforce and economic issues at small rural hospitals.