Surgery in rural America

Despite recent increased attention to ailing health-care systems in rural America, policy makers have paid relatively little attention to the status of rural surgery. This paucity of attention is rooted in a combination of poor communication and incomplete knowledge. Unfortunately, the scarce dialogue between advocates of rural surgery and policy makers has been driven largely by anecdotes and generalizations. What is needed as a foundation for productive discourse is evidence-based objective observations regarding important issues and concerns related to rural surgical practice. This article reviews our current understanding of several of these issues; namely, the adequacy of the current and future surgical workforce, preparation for rural practice, professional isolation, rural surgical quality, and the critical interplay between rural surgeons and local systems of care in which they function. The intent of this article is to stimulate further inquiry that will create a foundation for meaningful dialogue between rural surgeons, surgical leaders, and health-care policy makers.