title: Threats to rural surgery.
abstract: BACKGROUND
  Rural surgery is a subject that often is discussed but little has been done to address the problems of rural surgery. With a decreased interest in broad-based general surgery, an aging population (especially in rural America), an aging population of general surgeons who are retiring early, surgical care in rural North America is approaching a crisis.
  
  
  METHODS
  An internet search was performed to analyze the problems in rural surgery. Also, the experience of a 90-bed rural hospital in south central Kentucky was analyzed.
  
  
  RESULTS
  Approximately 17% to 25% of the population in America (55 million) live in a rural environment, depending on the way rural is defined. Rural general surgeons may become an endangered species because of multiple factors, including: lack of broad-based training, increased specialization, lifestyle issues, decreased interest in surgery, increased technology, aging rural surgeons, increased workload for the general surgeon, decreased reimbursement, increased expenses, increased expectations of the general public, and increased malpractice costs. Solutions include programs dedicated to training rural surgeons, networking with university tertiary care hospitals, equal pay for work performed regardless of the location, regionalization of rural surgery centers with multiple surgeons so the lifestyle issues can be addressed.
  
  
  CONCLUSIONS
  There is an increasing need for broad-based general surgeons in rural America. Training programs need to address the problem by offering dedicated training programs that should include primary training in general surgery and fellowships for special needs. A new specialty in rural general surgery needs to be created.
authors: Department of Surgery, University of Louisville School of Medicine and Quality Surgical Solutions, Louisville, KY 40292, USA. USA@kih.net
authors: Eugene H
authors: EH
authors: Shively
authors: Susan A
authors: SA
authors: Shively
mesh_terms: D002983:Clinical Competence; D006780:Hospitals, Rural; D006801:Humans; D007629:Kentucky; D008297:Male; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D011365:Professional Practice Location; D018570:Risk Assessment; D012423:Rural Health; D019035:Rural Health Services / Q000639:trends*; D013043:Specialties, Surgical / Q000639:trends*; D000078329:Workforce