Some of these programs would not work in every rural (or urban) practice. A partnership practice helps considerably. The ability to step into a medical center position with patient acceptance has been important. We feel that many similar opportunities exist--we have more planned--for other surgeons, and should be utilized. Both our geographic isolation and our small medical community have given us a sense of need for continuing education that is perhaps more acute than that of the urban-based private practicing surgeon. However, one has only to look about at most university surgical grand rounds and to note the paucity of surgeons practicing in those urban communities to realize that the feeling of isolation of the rural surgeon may be a very positive and beneficial force in his continuing education.