Purpose: One-quarter of the United States of America's population lives in rural areas, but only 12.3% of physicians live and work in rural areas. Nearly one-quarter of the counties in Iowa boast a patient-to-physician ratio of 3000:1. The number of rural surgeons is decreasing, and current residency programs may not optimally train graduates for the spectrum of surgical practice seen in rural areas. The scope of surgical practice differs between rural and non-rural surgeons, and in this study, we identified the types of surgery performed by 6 rural Iowa surgeons and compared the practices of rural and non-rural surgeons in Iowa.
Methods: Data from personal interviews and questionnaires with rural Iowa general surgeons and rural Iowa hospital administrators and results from the Iowa General Surgeon Practice Opportunity Survey were analyzed retrospectively.
Results: In 1995, 31 general surgeons were recruiting a general surgeon partner, of which 25 were in rural Iowa communities. Eighteen rural Iowa Hospital administrators were actively recruiting a general surgeon during the same time period. In September 2000, many of these positions remained unfilled. A total of 4963 surgical procedures were performed by 6 rural Iowa general surgeons in Iowa in 1995. Endoscopic, alimentary, and obstetrics and gynecologic procedures were the most frequently performed. Excluding endoscopy, 26% of all procedures performed were procedures not among the Accreditation Council of Graduate Medial Education (ACGME) list of requirements for graduating surgical residents.
Conclusions: Rural Iowa general surgeons perform a large volume of surgery and more subspecialty procedures than do their non-rural counterparts. Surgical residency programs need to more adequately train residents interested in rural general surgery in an effort to increase the pool of graduating surgical residents trained to deal with the scope of procedures a rural practice offers. This will help reduce the shortage of rural general surgeons in the United States of America.