Patterns of surgical practice in a small rural hospital

A significant proportion of the population in the United States lives in rural areas, yet these areas are traditionally underserved in terms of surgical and other medical specialists. As a result, the operative experience of surgeons practicing in rural areas is different than that of surgeons operating in urban centers. This study was undertaken with the goal of delineating the surgical experience in a small hospital in rural Mississippi and correlating that with the training of surgical residents.

The operative experience between July 1, 1996, and December 31, 1998, of a single surgeon at Newton Regional Hospital in rural Newton, MS, was evaluated. All cases were classified as either traditional-general-surgical or nongeneral-surgical; the latter category was further divided into endoscopy, gynecology, orthopedic, ENT, urology, and vascular.

A total of 1,153 operations was performed by the one-man surgical department during the study period. Traditional general surgery patients accounted for 50.6% of the total, endoscopy totalled 21%, and vascular patients totalled 2.6%. The remaining 25.8% were stratified as follows: gynecology, 4.3%; orthopedics, 10.3%; ENT, 3.5%; and urology, 7.7%.

The operative experience in a small rural hospital is significantly different from that at larger urban centers and is also markedly different from the experience of residents in major teaching centers. This would suggest the need to broaden the experience of graduating residents intending to practice in a rural setting.