INTRODUCTION
Of the 3,436 Federal Hospital Service Areas in the United States, 30% have fewer than 3 surgical specialists and 18% have no surgical specialist at all. The American College of Surgeons has thus designated this 48% of hospital districts as having a critical shortage of surgeons. These districts are largely rural. There is currently a crisis in rural medicine because of doctor, and especially surgeon, shortages. Plastic surgeons are needed in rural surgery because of their wide scope of surgical skills. Organized medical education now needs to be part of the solution.
METHODS
Believing that this crisis cannot be solved without working to attract residents to rural areas, we initiated a rural plastic surgery residency rotation in rural Oregon. The goals of the program were to acquaint residents with life in a small town, and with the scope and character of a plastic surgery practice in a rural setting. A major goal was to demonstrate that they can be an effective surgeon without the vast consulting resources of a university hospital.
RESULTS
Residents worked within a multispecialty clinic and operative experience was located at the local 172-bed hospital. Patients came from an expansive rural area spanning greater than 200 miles. All aspects of plastic surgery were experienced, new approaches to carpometacarpal arthroplasty were performed and reported in academic presentations. Survey results demonstrated that most rural plastic surgery patients are being referred from surrounding generalist and specialists, but there is a general lack of knowledge in these patients and referring physicians of the large diversity of services a plastic surgeon’s practice can offer.
CONCLUSIONS
Plastic surgery residents cannot be expected to seek out practice opportunities in small towns without having been raised in one or having experienced the practice of medicine in these communities. This program proved very successful, but it is only a beginning. Medical education must recruit students with rural backgrounds. All medical students and residents should have a rural training experience. Academic training centers must invest and reward those who aspire to choose a rural practice. Without a rural experience, today’s residents will never imagine nor take advantage of all the benefits that rural plastic surgery can provide.
Footnotes
Presented at the American Council of Academic Plastic Surgeons 4th Annual Winter Retreat, December 9–11, 2016, Chicago, Ill.
Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge for this abstract was paid for by the American Council of Academic Plastic Surgeons.
ACAPS: American Council of Academic Plastic Surgeons (ACAPS) Winter Retreat, in Chicago, Illinois, December 9–11, 2016.