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Spectrum of general surgery in rural America
J Landercasper1, M Bintz, T H Cogbill
1Department of General Surgery, Gundersen Lutheran Medical Center, La Crosse, Wis, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|May 1, 1997
Summary
Rural general surgeons perform a high volume of diverse procedures with low mortality. Their operative experience differs significantly from graduating US surgical residents, highlighting a need for specialized rural training programs.
Area of Science:
- General Surgery
- Rural Health
- Surgical Education
Background:
- Rural surgeons provide essential surgical services in underserved areas.
- Understanding the scope of rural surgical practice is crucial for healthcare planning.
- Comparing rural surgeons' experience with resident training informs educational reforms.
Purpose of the Study:
- To define the surgical procedures undertaken by rural general surgeons.
- To compare the operative experience of rural surgeons with that of recent US surgical residency graduates.
- To document the postoperative mortality rates for surgeries performed in rural settings.
Main Methods:
- A prospective registry of surgical cases from 7 rural general surgeons over 15 months.
- Comparison of collected data with the 1995 Report C (Resident Operative Logs).
- A national survey of surgical residency programs regarding formal gynecology training.
Main Results:
- Seven rural surgeons performed 2,420 procedures across various specialties, including endoscopy (28.3%) and gynecology (20.6%).
- Postoperative mortality was low at 0.25% (6 deaths).
- Graduating residents had limited experience in obstetrics, gynecology, and orthopedics compared to rural surgeons; 52% of programs lacked OB/GYN rotations.
Conclusions:
- Rural general surgeons manage a substantial caseload with favorable outcomes.
- A significant disparity exists between rural surgical practice and resident training experiences.
- Implementing a rural surgical track in residency programs is recommended to better prepare surgeons for rural practice.
