Compared to urban areas, rural communities had a 21 percent higher rate of deaths due to heart disease and a 15 percent higher rate of cancer deaths from 2001 to 2019. The per capita number of general surgeons decreased from 6.4 to 5.2 per 100,000 population (−18 percent) during the same period, further highlighting disparities in rural care.
The recruitment of rural physicians and surgeons remains a challenge. While there has been an emphasis on increasing primary care physicians in rural areas and supplementing physician shortages by incorporating nurse practitioners and physician assistants, the challenges remain. The COVID-19 pandemic led to widespread adoption of telehealth services; however, surgical care is unique in that it cannot be delivered remotely. Current research efforts focus on recruiting more physicians, opening more medical schools, and providing financial incentives and scholarships to retain providers in rural areas. To address surgical disparities, some residency programs have incorporated surgery rotations in rural areas as part of training. However, there has not been sufficient research or a standardized model to improve rural surgical care delivery—one where surgeons go to the patients and spend time in rural communities. Reducing the need for patients to travel to urban areas to receive surgical care and allowing them to recover at home may also promote faster recovery, reduce postoperative complications, and lower financial burdens.
If we take a global health perspective to deliver rural surgical care and have hospital systems send urban health care teams to rural centers on a rolling basis—spending a week or two every six months—the extended stay would allow health care teams to provide all aspects of surgical care, including pre-operative, operative, and post-operative services, rather than just itinerant care. Traveling to rural centers may offer urban surgical teams temporary relief from their usual high case volumes and a change in practice setting, potentially reducing burnout. We specifically use the term “surgical care teams” to include the surgical technicians, nurses, and other staff who would travel with the surgeon to rural areas. This immersion experience can help familiarize urban teams with the local community’s culture and attitudes toward health care, ensuring respect for the autonomy and views of local populations. These trips can also serve as team-building experiences and boost team morale. Additionally, we propose that rural health care teams take turns traveling to urban areas, as high volumes and case diversity may help them retain and improve their surgical skills.
Finally, like global medical and surgical mission trips, organizing rural mission trips and making them more attractive to health care staff, trainees, and students have not been widely explored. Many health care workers and students spend thousands of dollars to travel internationally to provide care, but rural care can often be delivered within driving distance from their home. Mission trips have shortcomings, and it is important to act ethically and within the limits of one’s training and licensure to ensure long-term benefit to local communities.
Conclusion
In summary, disparities in rural surgical care are increasing each year. In addition to already existing programs designed to improve rural health care, the described approach of sending surgical teams to rural areas, rotating rural teams through urban centers, and organizing rural surgery mission trips can directly address the surgical needs of rural communities while supporting faster patient recovery and reducing potential clinician burnout.
Written with feedback from Sarah Rosmarin, PA-C, and Mary Haus, MD.
Ankit Jain is a medical student.
