Determining the sweet spot for rural hospital engagement in general surgery training

The shortage of rural general surgeons in the U.S. limits access to surgical care for rural communities. Rural training opportunities prepare surgery residents for rural practice and offer a solution to this workforce crisis. Rural-focused graduate medical education (GME) funding has had limited uptake for general surgery. This study sought to determine whether procedure volume at rural hospitals might limit training opportunities.

The authors performed a cross-sectional study of fiscal year 2019 inpatient discharge data for a multi-state cohort of inpatient discharges in Arizona, California, Iowa, North Carolina, Vermont and Wisconsin. All rural hospitals not associated with a general surgery training program or currently receiving Federal GME funding were included. Rurality was defined using both Federal Office of Rural Health Policy (FORHP) and Centers for Medicare and Medicaid Services (CMS) criteria. The authors estimated the ability of rural hospitals to "host" general surgery residents as a function of the inpatient surgical volume at the hospital and resident case log requirements. Potential residents were classified as full (100% of procedure volume), or 51%, 30% or 20% of procedural volume.

Of the rural hospitals studied in six states, 467 were both GME-naïve and unaffiliated with a general surgery program. Among CMS and FORHP rural hospitals, 5-8 could host a full-time resident for 100% of the general surgery residency training time, 17-26 met criteria for greater than 50% of training time and 40-55 for at least 20% of training time.

This study reveals that few rural hospitals can establish general surgery residencies that meet current eligibility for Medicare GME financing of Rural Track Programs. Hosting rural rotations and partnering with hospitals for training offer substantial potential for rural general surgery GME expansion among rural hospitals.