Overcoming Geographic Barriers: Surgical Care in Rural Populations

This chapter examines the challenges rural Americans face in accessing surgical care, which is characterized by geographical barriers, a decreasing surgical workforce, and unique patient factors. The widening health care disparity between rural and urban residents highlights the need for comprehensive strategies to improve surgical care delivery to rural areas. Focusing on colorectal care delivery, encompassing the spectrum of common and complex care, exemplifies opportunities to optimize care delivery for rural populations. Here, we discuss the complex and unique interplay of challenges within rural hospital infrastructure, workforce shortages, and patient factors emphasizing financial strain, closure of rural hospitals, and limited access to specialty providers and resources. Current evidence focuses on volume-outcome relationships, the safety of common surgical care at rural hospitals, and the impact of rural hospitals joining larger health systems. Strategies to optimize care delivery include site-of-care optimization, improved care coordination, dissemination of specialty expertise, and policy programs to support the rural workforce. Recent federal policies, including the rural emergency hospital program, underscore the delicate balance between sustaining essential local health care services and the financial realities of rural health care delivery. We then conclude with evidence-based strategies to bridge the urban-rural health care gap, ensuring equitable access to high-quality surgical care regardless of geographic location.