title: How does degree of rurality impact the provision of surgical services at rural hospitals?
abstract: BACKGROUND
  Rural residents frequently have decreased access to surgical services. Consequences of this situation include increased travel time and financial costs for patients. There are also economic implications for hospitals as they may lose revenue when patients leave the area in order to obtain surgical services. Rural communities vary in size and distance from more populated centers. Since rural hospitals are located in varying types of rural communities, they likely differ with regard to the provision of surgical care.
  
  
  OBJECTIVE
  To describe the differences between hospitals located in smaller versus larger rural areas regarding the provision of surgical care.
  
  
  METHODS
  A 12-item survey instrument based on one previously used in a pilot study was mailed to a national random sample of rural hospital administrators (n = 233). Rural location was determined using rural-urban commuting area codes.
  
  
  RESULTS
  One hundred and eleven surveys were received, yielding a 48% response rate. Hospitals in larger rural areas had an average of 9 surgeons compared to 1 at hospitals in smaller rural areas. More administrators at hospitals located in larger rural areas viewed the ability to provide surgical care as very important to the financial viability of their hospital.
  
  
  CONCLUSIONS
  Among rural hospitals located in communities of varying sizes there are significant differences in how surgical services are delivered and the financial importance of providing surgical care. Administrators at hospitals located in larger rural areas, more than in smaller ones, report financial reliance on their ability to offer surgical care and have significantly more resources available to do so.
authors.affiliation: Mithoefer Center for Rural Surgery, Cooperstown, NY 13326, USA. brit.doty@bassett.org
authors.forename: Brit
authors.initials: B
authors.lastname: Doty
authors.forename: Randall
authors.initials: R
authors.lastname: Zuckerman
authors.forename: Samuel
authors.initials: S
authors.lastname: Finlayson
authors.forename: Paul
authors.initials: P
authors.lastname: Jenkins
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Rieb
authors.forename: Steven
authors.initials: S
authors.lastname: Heneghan
mesh_terms: D019538:Health Care Surveys; D006297:Health Services Accessibility; D006780:Hospitals, Rural; D006801:Humans; D009518:New York; D013503:Surgery Department, Hospital / Q000600:supply & distribution*