What Operations Should a Modern Rural Surgeon Do?

Rural patients have fewer complications and deaths, shorter hospital stay, and less resource utilization than their urban counterparts. They also tend to have fewer chronic illnesses; this reflects a system working as intended, with high-risk patients transferred to better-resourced institutions, while others receive surgical care closer to home. Deciding which operations a modern rural surgeon should-and shouldn't-perform starts with the question "Who decides?" Government, insurers, hospitals, surgeons, and patients are all stakeholders, with a vested interest in the answer.Rural hospitals depend on surgeons for their financial existence, and rural surgeons need hospitals to function. The closure of rural hospitals throughout the country threatens the future of rural surgery. Without surgeons, rural patients will die unnecessarily. During the first COVID surge, patients died from such basic surgical emergencies as small bowel obstruction, when tertiary referral hospitals were full. Rural surgeons are essential in providing timely care of the injured patient; even today, patients die in isolated facilities from treatable injuries from lack of a surgeon who can do a splenectomy, or tube thoracostomy for traumatic pneumothorax, for example.Recruitment of rural surgeons requires identifying interested trainees, often from rural backgrounds, and a defined residency curriculum with emphasis on endoscopy and vascular surgery plus basic gynecology, obstetrics, urology, and orthopedics. Financial incentives & credentials support are also essential for the new rural surgeon. We need to develop many more focused rural surgery programs, and quickly, before the possibility of a broadly skilled rural surgeon in the USA evaporates.

Uncovering the Overlap of Global and Domestic Rural Surgery for Medical Trainees.

INTRODUCTION: Medical trainees who participate in global rotations demonstrate improved cultural sensitivity, increased involvement in humanitarian efforts, and ability to adapt to limited resources. The global coronavirus pandemic halted global rotations for medical trainees. Domestic rural surgery (DRS) may offer a unique alternative. We aimed to understand medical students' perceptions of the similarities and differences between global surgery and DRS and how students' priorities impact career choices. METHODS: An electronic survey was administered at eleven medical training institutions in Indiana, Illinois, and Michigan in spring 2021. Mixed methods analysis was performed for students who reported an interest in global surgery. Quantitative analysis was completed using Stata 16.1. RESULTS: Of the 697 medical student respondents, 202 were interested in global surgery. Of those, only 18.3% were also interested in DRS. Students interested in DRS had more rural exposures. Rural exposures associated with DRS interest were pre-clinical courses (P = 0.002), clinical rotations (P = 0.045), and rural health interest groups (P < 0.001). Students interested in DRS and those unsure were less likely to prioritize careers involving teaching or research, program prestige, perceived career advancement, and well-equipped facilities. The students who were unsure were willing to utilize DRS exposures. CONCLUSIONS: Students interested in global surgery express a desire to practice in low-resource settings. Increased DRS exposures may help students to understand the overlap between global surgery and DRS when it comes to working with limited resources, achieving work-life balance and practice location.

Jugaad Trocar for a 5-mm Laparoscopic Cannula.

When we are practicing, especially in rural India, we often face problems of instrument failure or lost instrument, etc... which may sometimes necessitate abandoning the procedure just because of the lack of a single instrument. We do mobile laparoscopic surgery, carrying all the laparoscopic instruments to far-off places, as far as 60-80 km. On one such occasion, my staff had lost a 5-mm trocar, which had gone unnoticed until I posted a case for laparoscopic cholecystectomy. There was not much time to buy a new one and also it was difficult to procure from the dealer because of the COVID-19 situation. Just because of the lack of one instrument we were facing a situation of postponing laparoscopy!

US Rural Surgeons Leading During COVID-19: Where Are They Now?

Rural surgeons from disparate areas of the United States report on the effects of the COVID-19 pandemic in their communities as the virus has spread across the country. The pandemic has brought significant changes to the professional, economic, and social lives of the individual surgeons and their communities.

US Rural Surgeon Responses to the COVID-19 Pandemic: Leadership in a Time of Crisis.

Nine surgeons from rural and remote communities in the United States share early experiences preparing for the COVID-19 pandemic. Relating experiences remarkably different from health care providers in urban areas in America most affected by the first stages of the outbreak, they tell the challenges of organizing resources in facilities already struggling with poverty-stricken communities far from established health care resources and supplies. From Alaska to Appalachia and the Navajo Nation to the rural midwest, they show the leadership and professionalism that exemplify rural surgery.