Factors Correlated With Surgery Resident Choice to Practice General Surgery in a Rural Area

Jarman, Benjamin T.; Cogbill, Thomas H.; Mathiason, Michelle A.; O'Heron, Colette T.; Foley, Eugene F.; Martin, Ronald F.; Weigelt, John A.; Brasel, Karen J.; Webb, Travis P.

doi:10.1016/j.jsurg.2009.06.003

« Previous Next »Journal of Surgical Education
Volume 66, Issue 6 , Pages 319-324, November 2009

Factors Correlated With Surgery Resident Choice to Practice General Surgery in a Rural Area

Presented at the Association of Program Directors in Surgery meeting, Salt Lake City, Utah, May 2, 2009.

Benjamin T. Jarman, MD
- Department of General Surgery, Gundersen Lutheran Health System, La Crosse, Wisconsin
- Correspondence: Inquiries to Benjamin T. Jarman, MD, Gundersen Lutheran Health System, Department of Surgery, 1836 South Avenue, La Crosse, WI 54601; fax: (608) 775-4460
Thomas H. Cogbill, MD
- Department of General Surgery, Gundersen Lutheran Health System, La Crosse, Wisconsin
Michelle A. Mathiason, MS
- Department of Research, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin
Colette T. O'Heron
- Department of Medical Education, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin
Eugene F. Foley, MD
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Ronald F. Martin, MD
- Marshfield Clinic, Marshfield, Wisconsin
John A. Weigelt, MD
- Medical College of Wisconsin, Milwaukee, Wisconsin
Karen J. Brasel, MD
- Medical College of Wisconsin, Milwaukee, Wisconsin
Travis P. Webb, MD
- Medical College of Wisconsin, Milwaukee, Wisconsin

published online 28 September 2009.

Objective

General surgery workforce shortages in the rural United States are likely to worsen over the next decade. We sought to identify reasons that general surgery residency graduates choose rural versus urban practice.

Design

Questionnaires were sent to 1994 through 2008 graduates of all 4 Wisconsin surgery residency programs (2 university and 2 community). The 51-item questionnaire was designed to evaluate residency graduates' background, interests, and factors influencing their choice of practice type and location. Graduates were divided into 2 groups based upon the size of the communities in which they currently practice: rural (<50,000) or urban (≥50,000). Data were analyzed using χ² tests; level of confidence was defined as p < 0.05.

Results

Forty-five percent (98/216) of surveys were completed. Factors associated with rural practice included attending a nonurban high school (p = 0.001) or college (p = 0.001), having a spouse/partner who grew up in a nonurban area (p = 0.022), and interest in hunting birds (p = 0.010) or large game (p = 0.001). Those choosing rural practice were more likely than their urban counterparts to have completed a rural clerkship during medical school (79% vs. 37%, p = 0.001). They were also more likely to have chosen a surgical residency program committed to rural training (p = 0.046). Graduates in rural practice more often cited “broad scope of practice” as an important reason for their decision. Both rural and urban surgeons reported similar rates of medical student teaching but urban surgeons were more likely to teach surgical residents (p = 0.001) and to have completed fellowship training (p = 0.001).

Conclusions

General surgery residency graduates and their spouses who choose rural practices are more likely than those selecting urban practices to have rural backgrounds and interests. Completing a rural clerkship during medical school and choosing a residency program committed to rural general surgery preparation are strongly correlated with rural practice. These findings may help formulate strategies to increase recruitment and retention of rural general surgeons.

Key Words: general surgery residency, rural clerkship, rural surgery

Competency: Professionalism, Systems-Based Practice