The Future of Rural Orthopaedic Practice: A Resident Survey Study

Those who live in rural areas generally exhibit higher prevalence of musculoskeletal conditions than urban populations. Already limited access to local orthopaedic care is becoming more challenging, as orthopaedic surgeons in these areas tend to be older and nearing retirement, while few graduating residents are selecting rural practice. However, little data exist on why orthopaedic residents are not choosing rural practice despite the clear need.

A 22-question survey was created in REDCap. A letter of invitation to participate was sent to interested program directors through the AOA Collaborative Orthopaedic Education Research Group (COERG). Questions included those related to community of origin, level of interest in rural practice, and areas in which more information is needed.

One hundred seven orthopaedic surgery residents from 16 programs completed the survey. Only 6 respondents plan to practice in rural areas. Thirty-two reported no interest in rural practice. Sixty-nine respondents were unsure about rural practice. No significant differences in rural interest were found based on gender or parental status. The only demographic factor impacting interest in rural practice was coming from a rural background. Factors leading to interest or disinterest in rural practice were similar. Those indicating that they were unsure wanted more information regarding impact on families, call, compensation, and case volume and complexity.

Addressing the gap in rural orthopaedic care is complex, but there are opportunities such as outreach to rural students to encourage them to consider medicine and then orthopaedic surgery as a career, as well as education sessions and rotations during residency training to expand rural interest.

Understanding the factors that lead to orthopaedic residents pursuing (or not) practice in rural areas is important in addressing access to musculoskeletal care in these areas.