•  
  •  
 

Keywords

Physician Supply, Rural Surgery, General Surgery, Surgical Education, Rural Nebraska

Abstract

Purpose: To examine the reasons fewer students and residents are entering general surgery, to educate residents about the realities of rural general surgery based on the experience of three general surgeons in central Nebraska, and to suggest a strategy for individual general surgeons and for residency programs to maintain the rural surgical workforce.

Methods: A systematic literature review of surveys, review articles, and editorials through PUBMED was performed. Relevant studies were included in a review of the current literature on the rural general surgery workforce, general surgery residency, fellowship training, and rural surgery education.

Findings: There is an insufficient supply of general surgeons in many parts of the country, particularly in rural settings. More general surgery residents are entering into subspecialty fellowship training and fewer are practicing general surgery than in the past. Residents may have inaccurate perceptions about rural general surgery practice. Those residency programs with dedicated rural and community surgery rotations have had more success in producing rural general surgeons.

Conclusions: Although specialization in surgery has many positive effects, maintenance of a general surgical workforce in rural America is crucial to the health care of many citizens. Increasing the numbers of mentoring and training programs could provide medical students and general surgery residents with more educational opportunities that may lead to increased interest in rural surgery.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

References

1. Yeo H, Viola K, Berg D, Lin Z, Nunez-Smith M, Cammann C, Bell RH Jr, Sosa JA, Krumholz HM, Curry LA. Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents: A National Survey. JAMA. 2009;302(12):1301-1308.
http://dx.doi.org/10.1001/jama.2009.1386
PMid:19773565

2. Richardson JD. Workforce and Lifestyle Issues in General Surgery Training and Practice. Arch Surg. 2002;137:515-520.

3. Bell Jr R., Banker M, Rhodes R, Biester T, Lewis F. Graduate Medical Education in Surgery in the United States. Surgical Clinics of North America. 2007;87(4):811-823.
http://dx.doi.org/10.1016/j.suc.2007.06.005
PMid:17888781

4. Bell RH Jr. Graduate education in general surgery and its related specialties and subspecialties in the United States. World J Surg. 2008 Oct;32(10):2178-84.
http://dx.doi.org/10.1007/s00268-008-9658-x
PMid:18581168

5. Richardson JD. Workforce and Lifestyle Issues in General Surgery Training and Practice. Arch Surg. 2002;137:515-520.

6. Borgstrom DC, Heneghan SJ. Bassett healthcare rural surgery experience. Surg Clin North Am. 2009;89(6):1321-3,viii-ix.
http://dx.doi.org/10.1016/j.suc.2009.07.011
PMid:19944814

7. Heneghan SJ, Bordley J 4th, Dietz PA, Gold MS, Jenkins PL, Zuckerman RJ. Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements. J Am Coll Surg. 2005;201(5):732-6.
http://dx.doi.org/10.1016/j.jamcollsurg.2005.06.262
PMid:16256916

8. Zuckerman R, Doty B, Bark K, Heneghan S. Rural versus non-rural differences in surgeon performed endoscopy: results of a national survey. Am Surg. 2007;73(9):903-5.
PMid:17939423

9. Fischer JE. The impending disappearance of the general surgeon. JAMA. 2007;298(18):2191-2193.
http://dx.doi.org/10.1001/jama.298.18.2191
PMid:18000204

10. Cofer JB, Burns RP. The Developing Crisis in the National General Surgery Workforce. J Am Coll Surg 2008;206:790-796.
http://dx.doi.org/10.1016/j.jamcollsurg.2007.12.017
PMid:18471697

11. Fischer JE. The impending disappearance of the general surgeon. JAMA. 2007;298(18):2191-2193.
http://dx.doi.org/10.1001/jama.298.18.2191
PMid:18000204

12. Charles AG, Walker EG, Poley ST, Sheldon GF, Ricketts TC, Meyer AA. Increasing the number of trainees in general surgery residencies: is there capacity? Acad Med. 2011 May;86(5):599-604.
http://dx.doi.org/10.1097/ACM.0b013e318212eb17
PMid:21436659

13. Charles AG, Walker EG, Poley ST, Sheldon GF, Ricketts TC, Meyer AA. Increasing the number of trainees in general surgery residencies: is there capacity? Acad Med. 2011 May;86(5):599-604.
http://dx.doi.org/10.1097/ACM.0b013e318212eb17
PMid:21436659

14. Lynge DC, Larson EH, Thompson MJ, Rosenblatt RA, Hart LG. A longitudinal analysis of the general surgery workforce in the United States, 1981-2005. Arch Surg. 2008;143(4):345-50; discussion 351.
http://dx.doi.org/10.1001/archsurg.143.4.345
PMid:18427021

15. Bell RH Jr. Graduate education in general surgery and its related specialties and subspecialties in the United States. World J Surg. 2008 Oct;32(10):2178-84.
http://dx.doi.org/10.1007/s00268-008-9658-x
PMid:18581168

16. Borgstrom DC, Heneghan SJ. Bassett healthcare rural surgery experience. Surg Clin North Am. 2009;89(6):1321-3,viii-ix.
http://dx.doi.org/10.1016/j.suc.2009.07.011
PMid:19944814

17. Heneghan SJ, Bordley J 4th, Dietz PA, Gold MS, Jenkins PL, Zuckerman RJ. Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements. J Am Coll Surg. 2005;201(5):732-6.
http://dx.doi.org/10.1016/j.jamcollsurg.2005.06.262
PMid:16256916

18. Zuckerman R, Doty B, Gold M, et al. General surgery programs in small rural New York state hospitals: a pilot survey of hospital administrators. J Rural Health. 2006;22(4):339-342.
http://dx.doi.org/10.1111/j.1748-0361.2006.00055.x
PMid:17010031

19. On-call specialist coverage in U.S. emergency departments: ACEP survey of emergency department directors. American College of Emergency Physicians (Emergency Medicine Foundation) Website. April 2006. http://www3.acep.org/WorkArea/showcontent.aspx?id=33266. Accessibility verified October 23, 2007.

20. Stitzenberg KB, Sheldon GF. Progressive specialization within general surgery: adding to the complexity of workforce planning. J Am Coll Surg. 2005 Dec;201(6):925-32.
http://dx.doi.org/10.1016/j.jamcollsurg.2005.06.253
PMid:16310697

21. Richardson JD. Workforce and Lifestyle Issues in General Surgery Training and Practice. Arch Surg. 2002;137:515-520.

22. Bell Jr R., Banker M, Rhodes R, Biester T, Lewis F. Graduate Medical Education in Surgery in the United States. Surgical Clinics of North America. 2007;87(4):811-823.
http://dx.doi.org/10.1016/j.suc.2007.06.005
PMid:17888781

23. Heneghan SJ, Bordley J 4th, Dietz PA, Gold MS, Jenkins PL, Zuckerman RJ. Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements. J Am Coll Surg. 2005;201(5):732-6.
http://dx.doi.org/10.1016/j.jamcollsurg.2005.06.262
PMid:16256916

24. Hoyt DB. Concerns about a physician workforce shortage have been mounting. Bull Am Coll Surg. 2010Jul;95(7):4-6.

25. Institute of Medicine: Hospital-based emergency care: at the breaking point. National Academies Press. Washington, DC 2006:163–200.

26. Sheldon GF. The surgeon shortage: constructive participation during health reform. J Am Coll Surg. 2010 Jun;210(6):887-94.
http://dx.doi.org/10.1016/j.jamcollsurg.2010.03.031
PMid:20510796

27. Sheldon GF. The evolving surgeon shortage in the health reform era. J Gastrointest Surg. 2011 Jul;15(7):1104-11. Epub 2011 May 6.
http://dx.doi.org/10.1007/s11605-011-1430-0
PMid:21547594

28. Stabile BE. The surgeon: a changing profile. Arch Surg. 2008;143(9):827-831.
http://dx.doi.org/10.1001/archsurg.143.9.827
PMid:18794418

29. Yeo H, Viola K, Berg D, Lin Z, Nunez-Smith M, Cammann C, Bell RH Jr, Sosa JA, Krumholz HM, Curry LA. Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents: A National Survey. JAMA. 2009;302(12):1301-1308.
http://dx.doi.org/10.1001/jama.2009.1386
PMid:19773565

30. Thakur A, Thakur V, Fonkalsrud EW, Singh S, Buchmiller TL. The outcome of research training during surgical residency. J Surg Res. 2000;90(1):10-12.
http://dx.doi.org/10.1006/jsre.2000.5817
PMid:10781368

31. Heneghan SJ, Bordley J 4th, Dietz PA, Gold MS, Jenkins PL, Zuckerman RJ. Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements. J Am Coll Surg. 2005;201(5):732-6.
http://dx.doi.org/10.1016/j.jamcollsurg.2005.06.262
PMid:16256916

32. Cofer JB, Burns RP. The Developing Crisis in the National General Surgery Workforce. J Am Coll Surg 2008;206:790-796.
http://dx.doi.org/10.1016/j.jamcollsurg.2007.12.017
PMid:18471697

33. Russell TR. The surgical workforce: averting a patient access crisis. Surg Clin North Am. 2007;87(4):797-809,v.
http://dx.doi.org/10.1016/j.suc.2007.06.003
PMid:17888780

34. Doty B, Zuckerman R, Finlayson S, Jenkins P, Rieb N, Heneghan S. General surgery at rural hospitals: a national survey of rural hospital administrators. Surgery. 2008;143(5):599-606.
http://dx.doi.org/10.1016/j.surg.2007.11.022
PMid:18436007

35. Doty B, Heneghan SJ, Zuckerman R. General surgery contributes to the financial health of rural hospitals and communities. Surg Clin North Am. 2009;89(6):1383-7, x-xi.
http://dx.doi.org/10.1016/j.suc.2009.07.008
PMid:19944821

36. Doty B, Zuckerman R, Finlayson S, et al. When rural is not rural: an examination of surgical services at rural hospitals. Presented at: American Association of Medical Colleges Workforce Research Conference; May 3, 2007; Bethesda, MD. http://www.aamc.org/workforce/pwrc07/start.htm. Accessed August 10, 2010.

37. Chappel AR, Zuckerman RS, Finlayson SR. Small rural hospitals and high-risk operations: how would regionalization affect surgical volume and hospital revenue? J Am Coll Surg. 2006;203(5):599-604.
http://dx.doi.org/10.1016/j.jamcollsurg.2006.07.009
PMid:17084319

38. Doty B, Heneghan SJ, Zuckerman R. General surgery contributes to the financial health of rural hospitals and communities. Surg Clin North Am. 2009;89(6):1383-7, x-xi.
http://dx.doi.org/10.1016/j.suc.2009.07.008
PMid:19944821

39. Cofer JB, Burns RP. The Developing Crisis in the National General Surgery Workforce. J Am Coll Surg 2008;206:790-796.
http://dx.doi.org/10.1016/j.jamcollsurg.2007.12.017
PMid:18471697

40. Doty B, Zuckerman R, Finlayson S, Jenkins P, Rieb N, Heneghan S. General surgery at rural hospitals: a national survey of rural hospital administrators. Surgery. 2008;143(5):599-606.
http://dx.doi.org/10.1016/j.surg.2007.11.022
PMid:18436007

41. Yeo H, Viola K, Berg D, Lin Z, Nunez-Smith M, Cammann C, Bell RH Jr, Sosa JA, Krumholz HM, Curry LA. Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents: A National Survey. JAMA. 2009;302(12):1301-1308.
http://dx.doi.org/10.1001/jama.2009.1386
PMid:19773565

42. Viola KV, Bucholz E, Yeo H, Piper C, Bell Jr RH, Sosa JA. Impact of Family and Gender on Career Goals: Results of a National Survey of 4586 Surgery Residents. Arch Surg. 2010;145(5):418-424.
http://dx.doi.org/10.1001/archsurg.2010.64
PMid:20479338

43. Sue GR, Bucholz EM, Yeo H, Roman SA, Jones A, Bell Jr. RH, Sosa JA. The Vulnerable Stage of Dedicated Research Years of General Surgery Residency: Results of a National Survey. Arch Surg. 2011;146:653-658.
http://dx.doi.org/10.1001/archsurg.2011.12
PMid:21339415

44. Yeo H, Viola K, Berg D, Lin Z, Nunez-Smith M, Cammann C, Bell RH Jr, Sosa JA, Krumholz HM, Curry LA. Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents: A National Survey. JAMA. 2009;302(12):1301-1308.
http://dx.doi.org/10.1001/jama.2009.1386
PMid:19773565

45. Viola KV, Bucholz E, Yeo H, Piper C, Bell Jr RH, Sosa JA. Impact of Family and Gender on Career Goals: Results of a National Survey of 4586 Surgery Residents. Arch Surg. 2010;145(5):418-424.
http://dx.doi.org/10.1001/archsurg.2010.64
PMid:20479338

46. Sue GR, Bucholz EM, Yeo H, Roman SA, Jones A, Bell Jr. RH, Sosa JA. The Vulnerable Stage of Dedicated Research Years of General Surgery Residency: Results of a National Survey. Arch Surg. 2011;146:653-658.
http://dx.doi.org/10.1001/archsurg.2011.12
PMid:21339415

47. Borman KR, Vick LR, Biester TW, Mitchell ME. Changing Demographics of Residents Choosing Fellowships: Longterm Data from The American Board of Surgery. Presented at the Southern Surgical Association 119th Annual Meeting, Hot Springs, VA, December 2007.

48. Yeo H, Viola K, Berg D, Lin Z, Nunez-Smith M, Cammann C, Bell RH Jr, Sosa JA, Krumholz HM, Curry LA. Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents: A National Survey. JAMA. 2009;302(12):1301-1308.
http://dx.doi.org/10.1001/jama.2009.1386
PMid:19773565

49. Viola KV, Bucholz E, Yeo H, Piper C, Bell Jr RH, Sosa JA. Impact of Family and Gender on Career Goals: Results of a National Survey of 4586 Surgery Residents. Arch Surg. 2010;145(5):418-424.
http://dx.doi.org/10.1001/archsurg.2010.64
PMid:20479338

50. Borman KR, Vick LR, Biester TW, Mitchell ME. Changing Demographics of Residents Choosing Fellowships: Longterm Data from The American Board of Surgery. Presented at the Southern Surgical Association 119th Annual Meeting, Hot Springs, VA, December 2007.

51. Breon TA, Scott-Conner CE, Tracy RD. Spectrum of general surgery in rural Iowa. Curr Surg 2003;60:94–99.
http://dx.doi.org/10.1016/S0149-7944(02)00680-3

52. Breon TA. Rural surgical practice: an Iowa group model. Surg Clin North Am. 2009;89(6):1359-66, x.
http://dx.doi.org/10.1016/j.suc.2009.07.012
PMid:19944818

53. Stein K. Training for a rural surgical career: the reflections of two Gundersen Lutheran graduates. Bull Am Coll Surg. 2010;95(8):11-5.

54. Ritchie WP, Rhodes RS, Biester TW. Work loads and practice pattern of general surgeons in the United States, 1995_1997. Ann Surg. 1999;230:533–543.
http://dx.doi.org/10.1097/00000658-199910000-00009
PMid:10522723 PMCid:1420902

55. Heneghan SJ, Bordley J 4th, Dietz PA, Gold MS, Jenkins PL, Zuckerman RJ. Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements. J Am Coll Surg. 2005;201(5):732-6.
http://dx.doi.org/10.1016/j.jamcollsurg.2005.06.262
PMid:16256916

56. Breon TA, Scott-Conner CE, Tracy RD. Spectrum of general surgery in rural Iowa. Curr Surg 2003;60:94–99.
http://dx.doi.org/10.1016/S0149-7944(02)00680-3

57. Gates RL,Walker JT, Denning DA.Workforce patterns of rural surgeons in West Virginia. Am Surg. 2003;69:367–371.
PMid:12769205

58. Majure JA, Abernathy CM. Rural surgeons of Colorado: the scope of their practice. Bull Am Coll Surg. 1981;66:11–16.

59. Stevermer JJ, Supattanasire GJ,Williamson HA. Survey of general surgeons in rural Missouri: potential for rapid decrease in workforce. J Rural Health. 2001;17:59–62.
http://dx.doi.org/10.1111/j.1748-0361.2001.tb00255.x
PMid:11354723

60. Stevick J, Mullis E, Connally S, et al. Perspectives of rural practice in Georgia. Am Surg 1994;60:703–706.
PMid:8060044

61. King J, Fraher EP, Ricketts TC, Charles A, Sheldon GF, Meyer AA. Characteristics of practice among rural and urban general surgeons in North Carolina. Ann Surg. 2009;249(6):1052-60.
http://dx.doi.org/10.1097/SLA.0b013e3181a6cd57
PMid:19474673

62. Richardson JD. Workforce and Lifestyle Issues in General Surgery Training and Practice. Arch Surg. 2002;137:515-520.

63. Bell Jr R., Banker M, Rhodes R, Biester T, Lewis F. Graduate Medical Education in Surgery in the United States. Surgical Clinics of North America. 2007;87(4):811-823.
http://dx.doi.org/10.1016/j.suc.2007.06.005
PMid:17888781

64. Stein K. Training for a rural surgical career: the reflections of two Gundersen Lutheran graduates. Bull Am Coll Surg. 2010;95(8):11-5.

65. Richardson JD. Workforce and Lifestyle Issues in General Surgery Training and Practice. Arch Surg. 2002;137:515-520.

66. Are C, Stoddard HA, Huggett K, Franzen J, Mack A, Thompson JS. A regional perspective on the attitudes of fourth-year medical students toward the field of general surgery. J Surg Educ 2009;66(3):123-8.
http://dx.doi.org/10.1016/j.jsurg.2009.01.001
PMid:19712908

67. Barshes NR, Vavra AK, Miller A, et al. General surgery as a career: a contemporary review of factors central to medical student specialty choice. J Am Coll Surg. 2004;199:792–799.
http://dx.doi.org/10.1016/j.jamcollsurg.2004.05.281
PMid:15501122

68. Cochran A,Melby S,Neumayer LA. An internet-based survey of factors influencing medical student selection of a general surgery career. Am J Surg. 2005;189:742–746.
http://dx.doi.org/10.1016/j.amjsurg.2005.03.019
PMid:15910730

69. Yeo H, Viola K, Berg D, Lin Z, Nunez-Smith M, Cammann C, Bell RH Jr, Sosa JA, Krumholz HM, Curry LA. Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents: A National Survey. JAMA. 2009;302(12):1301-1308.
http://dx.doi.org/10.1001/jama.2009.1386
PMid:19773565

70. Breon TA. Rural surgical practice: an Iowa group model. Surg Clin North Am. 2009;89(6):1359-66, x.
http://dx.doi.org/10.1016/j.suc.2009.07.012
PMid:19944818

71. Stein K. Training for a rural surgical career: the reflections of two Gundersen Lutheran graduates. Bull Am Coll Surg. 2010;95(8):11-5.

72. Sanfey HA, Saalwachter-Schulman AR, Nyhof-Young JM. Influences on medical student career choice: gender or generation? Arch Surg. 2006;141:1086-1094.
http://dx.doi.org/10.1001/archsurg.141.11.1086
PMid:17116801

73. Breon TA. Rural surgical practice: an Iowa group model. Surg Clin North Am. 2009;89(6):1359-66, x.
http://dx.doi.org/10.1016/j.suc.2009.07.012
PMid:19944818

74. Stein K. Training for a rural surgical career: the reflections of two Gundersen Lutheran graduates. Bull Am Coll Surg. 2010;95(8):11-5.

75. Bell Jr R., Banker M, Rhodes R, Biester T, Lewis F. Graduate Medical Education in Surgery in the United States. Surgical Clinics of North America. 2007;87(4):811-823.
http://dx.doi.org/10.1016/j.suc.2007.06.005
PMid:17888781

76. Doty B, Zuckerman R, Borgstrom D. Are General Surgery Residency Programs Likely to Prepare Future Rural Surgeons? J Surg Ed. 2009;(66)2:74-79.

77. Borgstrom DC, Heneghan SJ. Bassett healthcare rural surgery experience. Surg Clin North Am. 2009;89(6):1321-3,viii-ix.
http://dx.doi.org/10.1016/j.suc.2009.07.011
PMid:19944814

78. Cofer JB, Burns RP. The Developing Crisis in the National General Surgery Workforce. J Am Coll Surg 2008;206:790-796.
http://dx.doi.org/10.1016/j.jamcollsurg.2007.12.017
PMid:18471697

79. Doty B, Zuckerman R, Borgstrom D. Are General Surgery Residency Programs Likely to Prepare Future Rural Surgeons? J Surg Ed. 2009;(66)2:74-79.

80. Antonenko DR. Rural Surgery: The North Dakota Experience. Surg Clin N Am 89(2009)1367–1372.
http://dx.doi.org/10.1016/j.suc.2009.07.010
PMid:19944819

81. Cogbill TH, Jarman BT. Rural General Surgery Training: The Gundersen Lutheran Approach. Surg Clin N Am 89(2009)1309–1312.
http://dx.doi.org/10.1016/j.suc.2009.07.006
PMid:19944812

82. Deveney K, Hunter J. Education for Rural Surgical Practice: The Oregon Health & Science University Model. Surg Clin N Am 89(2009)1303–1308.
http://dx.doi.org/10.1016/j.suc.2009.07.007
PMid:19944811

83. Giles WH, Arnold JD, Layman TS, Sumida MP, Brown PW, Burns RP, Cofer JB. Education of the Rural Surgeon: Experience from Tennessee. Surg Clin N Am. 89(2009)1313–1319.
http://dx.doi.org/10.1016/j.suc.2009.07.005
PMid:19944813

84. Cofer JB, Burns RP. The Developing Crisis in the National General Surgery Workforce. J Am Coll Surg 2008;206:790-796.
http://dx.doi.org/10.1016/j.jamcollsurg.2007.12.017
PMid:18471697

85. Cofer JB, Burns RP. The Developing Crisis in the National General Surgery Workforce. J Am Coll Surg 2008;206:790-796.
http://dx.doi.org/10.1016/j.jamcollsurg.2007.12.017
PMid:18471697

86. Giles WH, Arnold JD, Layman TS, Sumida MP, Brown PW, Burns RP, Cofer JB. Education of the Rural Surgeon: Experience from Tennessee. Surg Clin N Am. 89(2009)1313–1319.
http://dx.doi.org/10.1016/j.suc.2009.07.005
PMid:19944813

87. Antonenko DR. Rural Surgery: The North Dakota Experience. Surg Clin N Am 89(2009)1367–1372.
http://dx.doi.org/10.1016/j.suc.2009.07.010
PMid:19944819

88. Landercasper J, Bintz M, Cogbill TH. Spectrum of general surgery in rural America. Arch Surg. 1997;132(5):494–6.
http://dx.doi.org/10.1001/archsurg.1997.01430290040005
PMid:9161391

89. Bintz M, Cogbill TH, Bacon J. Rural trauma care: role of the general surgeon. J Trauma. 1996;41(3):462–4.
http://dx.doi.org/10.1097/00005373-199609000-00012

90. Ruby BJ, Cogbill TH, Gardner RS. Role of the rural general surgeon in a statewide trauma system: the Wyoming experience. Bull Am Coll Surg. 2006;91(4):37–40.
PMid:18557063

91. Cogbill TH. Training surgeons for rural America. Am Surg 2007;73(2):148–51.
PMid:17305291

92. Cogbill TH, Jarman BT. Rural General Surgery Training: The Gundersen Lutheran Approach. Surg Clin N Am 89(2009)1309–1312.
http://dx.doi.org/10.1016/j.suc.2009.07.006
PMid:19944812

93. Borgstrom DC, Heneghan SJ. Bassett healthcare rural surgery experience. Surg Clin North Am. 2009;89(6):1321-3,viii-ix.
http://dx.doi.org/10.1016/j.suc.2009.07.011
PMid:19944814

94. Deveney K, Hunter J. Education for Rural Surgical Practice: The Oregon Health & Science University Model. Surg Clin N Am 89(2009)1303–1308.
http://dx.doi.org/10.1016/j.suc.2009.07.007
PMid:19944811

95. Giles WH, Arnold JD, Layman TS, Sumida MP, Brown PW, Burns RP, Cofer JB. Education of the Rural Surgeon: Experience from Tennessee. Surg Clin N Am. 89(2009)1313–1319.
http://dx.doi.org/10.1016/j.suc.2009.07.005
PMid:19944813

96. Doty B, Zuckerman R, Borgstrom D. Are General Surgery Residency Programs Likely to Prepare Future Rural Surgeons? J Surg Ed. 2009;(66)2:74-79.

97. Heneghan SJ, Bordley J 4th, Dietz PA, Gold MS, Jenkins PL, Zuckerman RJ. Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements. J Am Coll Surg. 2005;201(5):732-6.
http://dx.doi.org/10.1016/j.jamcollsurg.2005.06.262
PMid:16256916

98. Stabile BE. The surgeon: a changing profile. Arch Surg. 2008;143(9):827-831.
http://dx.doi.org/10.1001/archsurg.143.9.827
PMid:18794418

99. Danto LA. National rural health service, comment on Bull Am Coll Surg. 2010 Apr;95(4):16-8; discussion 19. Bull Am Coll Surg. 2010 Aug;95(8):43.

100. Sutherland MJ. A young surgeon's perspective on alternate surgical training pathways. Am Surg. 2007;73(2):114-9.
PMid:17305285

101. McCord JH, McDonald R, Sippel RS, Leverson G, Mahvi DM, Weber SM. Surgical career choices: the vital impact of mentoring. J Surg Res. 2009;155(1):136-41.
http://dx.doi.org/10.1016/j.jss.2008.06.048
PMid:19041099

102. McCord JH, McDonald R, Sippel RS, Leverson G, Mahvi DM, Weber SM. Surgical career choices: the vital impact of mentoring. J Surg Res. 2009;155(1):136-41.
http://dx.doi.org/10.1016/j.jss.2008.06.048
PMid:19041099

103. McCord JH, McDonald R, Sippel RS, Leverson G, Mahvi DM, Weber SM. Surgical career choices: the vital impact of mentoring. J Surg Res. 2009;155(1):136-41.
http://dx.doi.org/10.1016/j.jss.2008.06.048
PMid:19041099

104. Reed CE, Vaporciyan AA, Erikson C, Dill MJ, Carpenter AJ, Guleserian KJ, Merrill WH. Factors dominating choice of surgical specialty. J Am Coll Surg. 2010 Mar;210(3):319-24.
http://dx.doi.org/10.1016/j.jamcollsurg.2009.11.016
PMid:20193895

105. Vick LR, Borman KR. Instability of fellowship intentions during general surgery residencies. J Surg Educ. 2008;65(6):445-52.
http://dx.doi.org/10.1016/j.jsurg.2008.07.003
PMid:19059176

106. Jarman BT, Cogbill TH, Mathiason MA, O'Heron CT, Foley EF, Martin RF, Weigelt JA, Brasel KJ, Webb TP. Factors correlated with surgery resident choice to practice general surgery in a rural area. J Surg Educ. 2009;66(6):319-24.
http://dx.doi.org/10.1016/j.jsurg.2009.06.003
PMid:20142128

107. Zarebczan B, McDonald RJ, Foley E, Weber SM. The dying field of general surgery: when do we intervene? J Surg Res. 2010;160(1):25-8.
http://dx.doi.org/10.1016/j.jss.2009.03.080
PMid:19631340

108. Jarman BT, Cogbill TH, Mathiason MA, O'Heron CT, Foley EF, Martin RF, Weigelt JA, Brasel KJ, Webb TP. Factors correlated with surgery resident choice to practice general surgery in a rural area. J Surg Educ. 2009;66(6):319-24.
http://dx.doi.org/10.1016/j.jsurg.2009.06.003
PMid:20142128

109. Zarebczan B, McDonald RJ, Foley E, Weber SM. The dying field of general surgery: when do we intervene? J Surg Res. 2010;160(1):25-8.
http://dx.doi.org/10.1016/j.jss.2009.03.080
PMid:19631340

110. Bell Jr R., Banker M, Rhodes R, Biester T, Lewis F. Graduate Medical Education in Surgery in the United States. Surgical Clinics of North America. 2007;87(4):811-823.
http://dx.doi.org/10.1016/j.suc.2007.06.005
PMid:17888781

111. Birkmeyer J.D., Stukel T.A., Siewers A.E., et al: Surgeon volume and operative mortality in the United States. N Engl J Med 349. (22): 2117-2127.2003.

112. Heneghan SJ, Bordley J 4th, Dietz PA, Gold MS, Jenkins PL, Zuckerman RJ. Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements. J Am Coll Surg. 2005;201(5):732-6.
http://dx.doi.org/10.1016/j.jamcollsurg.2005.06.262
PMid:16256916

113. Richardson JD. Workforce and Lifestyle Issues in General Surgery Training and Practice. Arch Surg. 2002;137:515-520.

114. Ferguson CM. The arguments against fellowship training and early specialization in general surgery. Arch Surg. 2003;138(8):915-6.
http://dx.doi.org/10.1001/archsurg.138.8.915
PMid:12912754

115. Ferguson CM. The arguments against fellowship training and early specialization in general su

Download

Share

COinS