Ensuring access to general surgical care in rural America: The role of general surgery residency programs

Background

Many rural residents lack access to general surgery services. Those living in remote rural areas often travel long distances to receive surgical care at a referral medical center and as a result may choose to delay or forgo surgical treatment because they are unable to leave home. One factor contributing to the problem is a lack of adequately trained rural surgeons. The number of surgeons per 100,000 in small/isolated rural areas is 4.67 as compared with 7.71 in large rural towns and 6.53 in urban centers. The deficit of rural surgeons is worsening as surgeons practicing in rural communities are on average older than their urban counterparts and fewer medical school graduates are choosing to practice general surgery. Graduate surgical training that provides residents with a wide variety of experiences while working in a rural setting is likely a promising strategy to prepare future general surgeons. The purpose of this study was to assess whether general surgery residency programs are positioned to train surgeons for rural practice.

Data Sources and Study Design

To determine rural location, the addresses of all 254 general surgery residency programs in the United States was obtained and zip codes were matched with those designated as rural in the Rural Urban Commuting Area code (RUCA) database. A search of the Fellowship and Residency Electronic Interactive Database (FREIDA) specifying general surgery residencies and rural training tracks (RTT) was completed to identify residency programs with an interest in training rural surgeons.

Key Findings

Five percent of residencies are either located in rural areas or have expressed an interest in training residents for rural practice. Five programs are located in rural areas with four situated in large rural locales (RUCA 4) and one is in a RUCA 10 community, the most rural setting. With regard to RTT's, 13 programs were identified as including this option as part of their residency program. One program is both located in a rural environment and offers a RTT opportunity within the residency curriculum.

Conclusions

These findings clearly show that we are not training surgeons who are likely to practice in rural areas. With 22% of the American population residing in rural communities and a significant number of surgeons planning to relocate or retire over the next decade, the number of surgeons being prepared to replace them is inadequate. Innovative educational strategies will be necessary to address this issue.