Introduction
Rural surgeons are the medical and economic cornerstones of their hospitals and communities. The COVID-19 pandemic devastated small business in the United States inclusive of rural surgeons and hospitals. We sought to estimate the financial impact of the pandemic upon rural surgery practices.
Methods
An anonymous survey was hosted on Qualtrics. Rural surgeons were identified through the ACS rural surgery communities page and listerv. 110 surveys were completed (23% response), with subjects from 38 states.
Results
Respondents were 71% male and 2/3 were 50-69 years old. Surgeons were primarily hospital-employed (51%), self-employed (27%), or group-employed (14%). Two-thirds reported decreases in income or benefits. 41% of practices terminated or reduced hours for employees. 7% of surgeons were furloughed and 3% were terminated. Surgeons estimated a mean reduction of 72% (IQR 30, range 20-100%) in overall clinical productivity. Endoscopy volumes were severely depressed, with a mean reduction of 81% (IQR 15, range 0-100%), followed by operative case volume 72% (IQR 30, range 9-100%) and outpatient visits 72% (IQR 30, range 24-100%). The pandemic affected retirement timelines for 40% of surgeons, with 30% reporting plans to retire later than planned. The largest groups now planning later retirement were aged 50-59 (24%) and aged 60-69 (35%). Regional reductions in productivity mirrored COVID-19 community penetrance.
Conclusion
The economic impact of the pandemic on rural healthcare has been significant. Rural surgery practices experienced significant reductions in clinical productivity. This likely had far-reaching economic consequences with most practices forced to reduce staffing or compensation.