The Surgical and Anesthesia Workforce and Provision of Surgical Services in Rural Communities: A Mixed‐Methods Examination

Abstract

Purpose: Rural-urban disparities in the surgical and anesthesia workforce exist. This mixed-methods study describes the distribution of the surgical and anesthesia workforce and qualitatively explores how such workforce and other factors influence rural hospitals' provision of surgical services. Methods: We calculated provider counts by county from the Area Health Resource File. Using American Hospital Association survey data, we sampled rural hospitals, stratified by critical access status and state policies. We conducted qualitative semistructured interviews with administrators at 16 hospitals and performed directed content analysis of factors influencing surgical services provision at rural hospitals. Findings: Within rural counties, 55.1% of counties had no surgeon, 81.2% had no anesthesiologist, and 58.1% had no Certified Registered Nurse Anesthetist (CRNA). Administrators reported that rural hospitals struggled to provide many surgical services given lack of subspecialty surgeons and adequate postsurgical care. Rural hospitals likely struggle to generate volumes necessary to support safe and profitable subspecialty surgery programs. Anesthesia services were not reported as a current limitation given that CRNAs in particular had strong, diverse skills sets and many hospitals allowed high CRNA autonomy. However, meeting anesthesia needs for emergency surgeries and 24-hour obstetrics posed significant challenges. Conclusions: While rural hospitals reported meeting community needs for elective and noncomplex surgeries, rural hospitals continued to face significant challenges providing subspecialty surgeries, emergency surgeries, and 24-hour obstetrical services.

Addressing Provider Shortages in Rural America: The Role of State Opt‐Out Policy Adoptions in Promoting Hospital Anesthesia Provision

“…However, other factors ultimately appear to predict the likelihood of hospitals providing CRNA services. 8 In addition to examining the opt-out policy's effect on the likelihood of hospitals providing CRNA services, here we also highlight the aforementioned county and organization level factors examined. While the opt-out results are not necessarily intuitive, other factors line up with what could be reasonably expected a priori.…”

“…Prior research suggests that opt-out policy adoption is a function of physician power or the relative power of CRNAs in a state. 2 It appears that more has to change than simply adopting an opt-out policy, 7,8 as opting out is potentially just a show of action decoupled from practice in reality. For one, increasing hospital CRNA provision will likely require addressing facility SOPs, a topic that could be addressed in future research.…”

“…Some researchers have found results congruent with the policy's intent, 5 yet opt-out states have not seen increased access in terms of higher numbers of specific procedures requiring anesthesia 6 or higher anesthesia utilization rates, 7 nor have they realized systematic reductions in CRNA clinical restrictions in hospitals. 8 Costs in opt-out states have also not decreased relative to nonopt-out states. 9 Although scholars have made attempts to link the opt-out policy to such outcomes, the research could be viewed as incomplete due to the lack of examining organization-level outcomes; removing barriers to anesthesia service provision for hospital facilities in opt-out states is a major goal of the opt-out policy.…”

Adoption and Safety Evaluation of Comfortable Nursing by Mobile Internet of Things in Pediatric Outpatient Sedation

“…Comfort care model, as a new type of medical care, has played an important role in various clinical diseases, such as postpartum care of parturients [ 19 ], care of patients with advanced cancer [ 20 ], and perioperative care of various diseases [ 21 , 22 ]. Among them, respiratory department diagnosis and treatment is particularly important for comfort care models due to the wide range of populations faced, especially for children.…”

Rural surgery

“… 16 In 2020, Cohen and colleagues found that among rural counties with at least a short-term general hospital, 50.8% were without a general surgeon, and slightly more, 52.2%, were without any surgical specialists. 21 Although these studies do not offer an apples-to-apples comparison, taken together they imply a dire situation in 2020, with one-half of all rural counties having no surgical services.…”