Migration of rural surgeons

Background: Although much attention has been focused recently on the declining ratio of general surgeons to population and the increasing number of rural counties without any surgeons, little is known about the migration patterns of the rural surgical workforce.

Methods: Using 2006 and 2009 AMA Masterfile data, licensed (non-resident) surgeons whose primary practice location was in a rural county in one but not both years were identified as movers. Rural counties were defined using the U.S. Office of Management and Budget's 2006 classification of nonmetropolitan places as those with a population ≤50,000. Demographic and geographic characteristics of rural-to-urban and urban-to-rural surgeon movers and rural surgeons who did not move were compared using Student's t-test, one-way ANOVA, Pearson's correlation and Spearman's correlation.

Results: A total of 3,706 surgeons (2%) were identified as having moved either to or from a rural area between 2006 and 2009; 46% moved from rural areas. The average distance of rural-to-urban movers and the proportion of surgeons moving to an adjacent county were comparable to those of urban-to-rural movers. Approximately 70% of all movers stayed within their same census region; surgeons leaving rural areas disproportionately moved to the South and West, whereas the regional distribution of those moving to rural areas did not change significantly.

Surgeons moving either to or from a rural place were significantly younger, more likely to be female, and less likely to be retired or semi-retired than those remaining in rural practice. Surgeons moving to rural areas were less likely to be foreign-trained than those remaining in rural practice (12% vs. 15%), whereas surgeons moving away from rural areas were more likely to be foreign-trained (17% vs. 15%). Compared to surgeons moving away from rural areas, surgeons moving to rural areas were significantly more likely to be female (17% vs. 14%). Surgeons moving away from rural areas were more likely to be foreign-trained and either retired or semi-retired (20% vs. 17%) than their counterparts moving to rural areas.

Conclusions: A considerable number of surgeons move in and out of rural areas and understanding the characteristics of those who move is important for developing targeted strategies to reduce movement and strengthen the rural surgical workforce. More research is needed to understand the reasons surgeons move in and out of rural areas.