Movers and Stayers: What Birthplaces Can Teach Us About Rural Practice Choice Among Midwestern General Surgeons

Abstract

This study compares practicing rural Midwestern general surgeons born in urban areas to those born in rural areas to describe the association between birthplace and current practice location. Methods: The 2017 AMA MasterFile was used to study general surgeons in the Midwest Census Division. Surgeons were assigned to categories based on birthplace and current practice locations: urban-urban stayers, urban-rural movers, rural-rural stayers, and rural-urban movers. Urban and rural classifications corresponded to the metropolitan and nonmetropolitan definitions with Rural-Urban Continuum Codes (urban, RUCCs 1-3; rural, RUCCs 4-9). Bivariate tests and logistic regression were used to determine factors associated with rural practice choice. Findings: There were 3,070 general surgeons in the study population: 70.6% urban-urban stayers, 13.1% urban-rural movers, 10.7% rural-urban movers, and 5.7% rural-rural stayers. Rural areas netted 74 surgeons (327 rural-urban movers versus 401 urban-rural movers). Logistic regression results found different factors predicted rural practice among urban-born versus rural-born surgeons. Older urban-born surgeons were more likely to practice rurally, as were male surgeons, DOs, and those trained in less-urban residency programs. Among rural-born surgeons, more rural birthplaces and having trained at a less-urban residency were associated with practicing rurally. Conclusions: Recruiting urban-born surgeons to rural areas has proven successful in the Midwest; our findings show urban-born surgeons outnumber rural-born surgeons in rural communities. Given the ongoing need for surgeons in rural areas, urban-born surgeons should not be overlooked. Findings suggest educators and community leaders should expand less-urban training opportunities given their potential influence on all general surgeons.

Possible relationship between rural surgical rotations during a residency period and an increased number of general surgeons in rural areas: a systematic review

“…Rural origin is well recognized as a predictor of work in rural areas 13) . In the present systematic review, one study described the possibility of rural residents becoming general surgeons in rural areas 47) . If possible, such programs may be recommended for individuals of rural origin, thereby promoting their participation in rural surgical rotations to increase the number of rural general surgeons.…”

“…| | doi: 10.2185/jrm.2022-031 2023; 18(1): 1-7 lectomy, and fracture management are usually proposed as skills in which proficiency is necessary for rural surgical rotations 36,56) . In fact, extensive experience with minor surgeries and subspecialties for rural surgery was emphasized in the programs in most studies in the present systematic review, as listed in Table 2 [44][45][46][47][48] . In addition, other aspects of these programs, such as the duration (which varied from as 2 to 12 months in some studies [44][45][46] ) and instructional methodology (one-on-one follow-up with a mentor in one study 44) ), should also be discussed.…”

“…Hughes 47) ND The programs included knowledge and skills necessary in rural areas with fewer than 250,000 population.…”

Rural surgery

“…The characteristics of a place have been shown to affect rural surgeon recruitment and retention. 33 , 34 This phenomenon has been more commonly studied among rural primary care physicians and rural health professionals broadly. 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 Recruitment and retention represent a clear and actionable connection between rural communities’ economic health and rural surgeons.…”

What Does It Mean for Medical School Admissions to Be Socially Accountable?

“…By working with local community colleges and academic enhancement programs, 45 providing funding for community-based prehealth initiatives, and bridging otherwise siloed pathway programs, several institutions are attempting to cultivate "hometown" physicians who are likely to return to serve their communities. 9,46,47,48 Other successful strategies for addressing health workforce shortages include selecting students from communities that have the greatest health needs 49,50 ; locating programs in or near the communities they serve, 51 particularly in primary care settings; integrating social determinants of health into the curriculum; and emphasizing a commitment to public service and social accountability across the institution. 52 Ultimately, social accountability must be an institutional priority or mission area in addition to education, research, and clinical care.…”