Impact of Rural Exposure During General Surgery Residency on Practice in a Rural Community.

Abstract

To evaluate associations between rural training exposure during surgical residency and eventual practice in a rural community, and whether specific types of exposure were more likely to yield rural surgeons. Growing deficits in the rural surgery workforce have prompted increased attention toward rural training. However, the association between exposure to rural surgery during residency and practice in rural communities remains limited. We performed a retrospective cohort study of U.S. general surgery residency graduates from 2011 to 2020. Program information was abstracted from residency websites, the American College of Surgeons, and the American Medical Association. A survey distributed to programs and direct review of residency websites were used to characterize the type of rural surgery exposure offered to trainees. We evaluated associations between exposure to rural surgery in training and ultimate practice in a rural location. Of 11,407 surgeons, 6.2% reported working in rural communities. Graduates of programs with rural training, according to residency websites or the American College of Surgeons, were more likely to work in rural areas [odds ratio: 1.81 (95% CI: 1.32-2.49) and 2.09 (1.28-3.40)]. Rurally located programs, rural rotations, and programs with a rural mission were associated with greater odds of graduates working in rural areas ( P < 0.05 for all). Rural tracks were not associated with more rural graduates. Among graduates of general surgery residency programs, rural exposures during training were associated with eventual practice in rural communities. Programs with rural missions, in rural locations, or offering rural rotations produced graduates who were more likely to work in rural areas, while rural track programs did not, highlighting the need for further study of individual rural exposure to establish effective training paradigms. Specific policies facilitating rural exposure and surgical programs in rural communities may be effective methods for addressing workforce deficits.