Summary of scope of practice findings
| Publication | Country | Context | Primary findings |
|---|---|---|---|
| Ang et al., 2020 (67) | Australia | Remote Australian base hospital; single institutional review of vascular emergencies | Rural surgeons located at base hospitals were required to complete emergency vascular surgery |
| Baldwin et al., 1999 (28) | United States | Comparison of rural physician practice with urban practice | Rural general surgeons were more likely to be referred patients requiring gastrointestinal workup |
| Bappayya et al., 2019 (68) | Australia | Review of procedures completed at a rural hospital by general surgeons | Endoscopy 35.9%; 5.4% of all procedures non–general surgery, including urology, vascular, and orthopedics |
| Bintz et al., 1996 (69) | United States | Rural American hospital review of traumas; Injury Severity Score 8–43 | 84 traumas reviewed; surgeons partook in trauma team resuscitations, procedures, or stabilization for transport, or provided local definitive treatment of patients |
| Breon et al., 2003 (29) | United States | Scope of practice of surgeons in rural Iowa | Endoscopy comprises a significant proportion of a rural surgeon’s practice Rural surgeons were more likely to complete cesarean deliveries, hip fracture, tonsillectomies, and urologic procedures than urban surgeons |
| Campbell et al., 2011 (70) | Australia | Assess the scope of practice of 2 practising surgeons in a rural hospital | 8336 procedures performed Traditional general surgery 44.3%, endoscopy 27.4%, other specialties: orthopedics, head and neck, neurosurgery, and obstetrics |
| Campbell et al., 2013 (71) | Australia | Assessment of the caseload of outreach surgeons | 18 029 procedures; 32% endoscopies; emergency procedures included vascular and neurosurgery |
| Cogbill and Bintz, 2017 (72) | United States | Assessment of scope of practice for a network of rural general surgeons | Colonoscopies account for 52% of rural surgeons’ practice, cesarean delivery 3.9%, and gynecology 2.2% |
| Etzioni et al., 2010 (40) | United States | Assess the proportion of emergency and elective colorectal cases being performed by a certified colorectal surgeon | In low population-density areas, emergency colorectal procedures are more likely to be performed by non–colorectal surgeons |
| Gates et al., 2003 (41) | United States | Survey of West Virginia rural surgeons | 27% of practice included obstetrics, urology, and orthopedics; also treated many medical problems |
| Gruber et al., 2015 (45) | United States | Assessment of laparoscopic v. open colectomy for colorectal cancer in Nebraska | Rural patients were 40% less likely to receive a laparoscopic colectomy |
| Harris et al., 2010 (46) | United States | Assessment of scope of practice for North and South Dakota general surgeons | Rural surgeons’ practice composed of 39.8% endoscopy and 25.6% general surgery procedures Surgeons in smaller centres performed more endoscopy and non–general surgery procedures (obstetrics, orthopedics, urology, and vascular) |
| Heneghan et al., 2005 (47) | United States | Assessment of practice and motivations of rural compared with urban surgeons | Rural surgeons were more likely to perform cesarean deliveries and gynecologic procedures Endoscopy accounts for a greater proportion of rural practice |
| Hilsden et al., 2007 (19) | Canada | Determine provincial and regional differences in endoscopy providers | Canadian rural surgeons completed 51% of all endoscopic procedures v. 35% by gastroenterologists |
| Komaravolu et al., 2019 (49) | United States | Assessment of the proportion of colonoscopies completed by general surgeons on rural patients | In rural areas, general surgeons performed 21.9% of all colonoscopies, whereas urban surgeons performed 3.1% of all urban colonoscopies |
| Kozhimannil et al., 2015 (73) | United States | Rates of births being attended by general surgeons | In low-volume centres, births were more likely to be attended by a general surgeon than by an obstetrician–gynecologist |
| Luck et al., 2015 (11) | Australia | Completion of emergency neurosurgical procedures by rural surgeons | Rural centres with resident general surgeons who completed all emergency neurosurgical procedures needed before transfer |
| Micieli et al., 2015 (20) | Canada | Assessment of temporal artery biopsies by region in Ontario | Surgeons were more often the provider in less populated regions |
| Moore et al., 2016 (55) | United States | Assessment of the frequency of laparoscopic colectomies performed by rural surgeons | Rural surgeons did not complete a high volume of colectomies; they were not frequently performed laparoscopically |
| Nealeigh et al., 2021 (18) | United States | Scoping review of literature surrounding American rural and deployed military surgeons | Approximately 20.7% of rural civilian surgical case volume is non–core general surgery, excluding endoscopy |
| Reynolds et al., 2003 (74) | United States | Assessment of training procedures in a rural community training centre | Graduating residents completed a high volume of advanced laparoscopic procedures in a rural setting |
| Rinker et al., 1998 (75) | United States | Assessment of local surgery training in emergency craniotomy | Based on need, a group of general surgeons completed training for emergency craniotomy by a neurosurgeon Over a follow-up period, 7 performed due to instability |
| Ritchie et al., 1999 (57) | United States | Assessment of scope of practice between rural and urban surgeons | Rural surgeons completed more endoscopy procedures, laparoscopy, and non–general surgery procedures |
| Sariego, 2000 (76) | United States | Review of a single rural surgeon’s endoscopic practice | Endoscopy accounted for 24% total procedures |
| Schroeder et al., 2020 (23) | Canada | Assessment of scope of practice of all rural Canadian surgeons | Rural surgeons were more likely to perform procedures outside of core general surgery, including endoscopy, orthopedics, and obstetrics |
| Sticca et al., 2012 (59) | United States | Evaluation of North Dakota rural surgeons’ scope of practice | 46 052 procedures completed by rural surgeons, 12.3% were non–general surgery procedures |
| Stiles et al., 2019 (60) | United States | Survey of rural surgeons, assessing scope of practice and preparedness | 43 of the rural surgeons surveyed frequently performed procedures from other specialties, including gynecology, otolaryngology, urology, and vascular surgery |
| Stinson et al., 2021 (61) | United States | Assessment of procedures most frequently performed by a rural surgeon | 38 958 procedures were assessed; 61.6% were endoscopic, cholecystectomy, or hernia repair related |
| Tulloh et al., 2001 (77) | Australia | Assessed the caseload of 3 rural general surgeons | Practice patterns varied between the 3 surgeons; frequently performed types of procedures included endoscopy, urology, vascular, and obstetrics |
| Valentine et al., 2011 (64) | United States | Examination of the scope of practice of American general surgeons between 2007 and 2009 | Rural surgeons performed significantly more endoscopic procedures; urban surgeons performed more laparoscopic procedures and abdominal procedures |
| VanBibber et al., 2006 (65) | United States | Comparison of rural with urban general surgery scope of practice | Rural surgeons were less likely to perform procedures on the stomach, pancreas, liver, or esophagus; they performed a greater number of obstetric and gynecologic, vascular, and head and neck procedures, which accounts for a greater proportion of inpatient procedures |
| Zuckerman et al., 2007 (66) | United States | Telephone survey of rural and urban surgeons assessing endoscopy volume | 74% of rural surgeons performed more than 50 endoscopic procedures in a year v. 33% of urban surgeons; 42% of rural surgeons completed > 200 procedures compared with 12% of urban surgeons |