Strategies to Improve the Rural Surgical Workforce

The rural surgical workforce is in crisis, resulting in significant health care access issues for the 60 million rural Americans. Rural surgeons encounter unique barriers to providing care for patients that are different than their urban counterparts. Rural hospitals are failing at an alarming rate. The American College of Surgeons (ACS) and the ACS Advisory Council for Rural Surgery have worked to improve communication among isolated rural surgeons and to bring recognition to rural surgeons as a distinct group. The rural workforce is aging at a rapid rate and multiple factors prevent newly trained surgeons from replacing those that retire. Loss of a surgeon in a small community leads to significant economic losses and possibly even closure of the local hospital. Changes in surgical training, subspecialization, demographic trends, and economic issues all lead to less numbers of young surgeons choosing to practice in small communities. Increasing the numbers of trainees will not reverse the trend unless it is combined with a change in the training paradigm for surgeons with a rural interest, additional funding for more rural training programs and financial support for surgeons to work in rural areas, and collaboration with urban and academic health care systems and their surgeons.