SAGES 2007 rural surgery panel

Abstract

Rural surgery: 59 million rural American citizens (2000 Census). Who cares? In 1999, SAGES President L. William Traverso articulated the importance of rural surgery and created the rural surgery task force. During the 2007 SAGES annual meeting in Las Vegas, the rural surgery task force, now turned into the rural surgery liaison group, presented a panel discussion that examined rural surgery manpower demographics, SAGES’ relationship with the rural surgeon, the American College of Surgeons’ advisory council for general surgery subcommittee on rural surgery, the challenges facing the practising rural surgeon, rural surgery contributions to medical education, and the education of the rural surgeon. It was the first SAGES public forum on rural surgery, and it may possibly be its last. In recent years, the SAGES rural surgery liaison group has conducted three internet surveys to understand the practice circumstances and needs of its rural members. In addition, SAGES’ rural surgery liaison group members made rural surgery presentations at the American College of Surgeons Washington/Oregon and Oklahoma 2006 chapter meetings and the Mithoefer Center for Rural Surgery second annual rural surgery symposium in Cooperstown, NY in September 2006. Members of the SAGES rural surgery liaison group also independently studied the use of endoscopy and laparoscopy in Wyoming, Montana, and Oklahoma. Here is what we know. Rural surgeons perform more procedures than their urban counterparts, nearly double the laparoscopic procedures and triple the number of endoscopies [1]. From the SAGES rural surgery surveys, we find that the nearest gastroenterologist is more than 20 miles distant in 50% of rural surgery practice situations. For screening colonoscopy, the rural general surgeon is the physician of first choice in 65% of rural surgery environments and second choice in 32%. Two-thirds of rural surgeons received their flexible endoscopy training during residency, and this trend will surely increase as the accreditation council for graduate medical education (ACGME) minimum-defined category numbers for endoscopy continue to increase. Only 42% of SAGES rural surgery members attend a SAGES meeting once every 5 years, and unfortunately 26% never attend a SAGES meeting. The most common (45%) referral population for a rural general surgeon is 0–25,000 people. The nearest tertiary hospital is C50 miles in 69% of rural surgery practices. At least two-thirds of SAGES rural surgeons take advantage of SAGES benefits (practice guidelines, privileging guidelines, or outcome case logs in conjunction with the American College of Surgeons). Three-quarters of rural surgeons are not interested in a PAC, but would like to see rural surgery better represented in the hierarchy of national surgical societies. We have significant gaps in our knowledge of rural surgery. Who is the rural surgeon: even a frontier surgeon? Rural surgeons have been defined by population [2] and rural–urban commuting codes [3]. Perhaps hospital size, numbers, and specialities of local supporting physicians, Health Professional Shortage Areas (HPSAs) as defined by the Department of Health and Human Services Health Resources and Services Administration for federal grants eligibility, specialty Physician Scarcity Areas (PSAs) created by the Centers for Medicare and Medicaid Services (CMS) for 5% physician bonus payments, and access to a skilled health care workforce would be equally important Presented at the Annual Meeting of the Society of American, Gastrointestinal and Endoscopic Surgeons (SAGES), Las Vegas, Nevada, USA, April 18, 2007.