Factors correlated with surgery resident choice to practice general surgery in a rural area.
OBJECTIVE
General surgery workforce shortages in the rural United States are likely to worsen over the next decade. We sought to identify reasons that general surgery residency graduates choose rural versus urban practice.


METHODS
Questionnaires were sent to 1994 through 2008 graduates of all 4 Wisconsin surgery residency programs (2 university and 2 community). The 51-item questionnaire was designed to evaluate residency graduates' background, interests, and factors influencing their choice of practice type and location. Graduates were divided into 2 groups based upon the size of the communities in which they currently practice: rural (<50,000) or urban (>or=50,000). Data were analyzed using chi(2) tests; level of confidence was defined as p < 0.05.


RESULTS
Forty-five percent (98/216) of surveys were completed. Factors associated with rural practice included attending a nonurban high school (p = 0.001) or college (p = 0.001), having a spouse/partner who grew up in a nonurban area (p = 0.022), and interest in hunting birds (p = 0.010) or large game (p = 0.001). Those choosing rural practice were more likely than their urban counterparts to have completed a rural clerkship during medical school (79% vs. 37%, p = 0.001). They were also more likely to have chosen a surgical residency program committed to rural training (p = 0.046). Graduates in rural practice more often cited "broad scope of practice" as an important reason for their decision. Both rural and urban surgeons reported similar rates of medical student teaching but urban surgeons were more likely to teach surgical residents (p = 0.001) and to have completed fellowship training (p = 0.001).


CONCLUSIONS
General surgery residency graduates and their spouses who choose rural practices are more likely than those selecting urban practices to have rural backgrounds and interests. Completing a rural clerkship during medical school and choosing a residency program committed to rural general surgery preparation are strongly correlated with rural practice. These findings may help formulate strategies to increase recruitment and retention of rural general surgeons.
Department of General Surgery, Gundersen Lutheran Health System, La Crosse, Wisconsin 54601, USA. BTJarman@gundluth.org <BTJarman@gundluth.org>
Benjamin T
BT
Jarman
Thomas H
TH
Cogbill
Michelle A
MA
Mathiason
Colette T
CT
O'Heron
Eugene F
EF
Foley
Ronald F
RF
Martin
John A
JA
Weigelt
Karen J
KJ
Brasel
Travis P
TP
Webb
D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D013502:General Surgery; D019538:Health Care Surveys; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D007588:Job Satisfaction; D008297:Male; D011336:Probability; D011365:Professional Practice Location / Q000706:statistics & numerical data; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D014481:United States; D019037:Urban Health Services; D000078329:Workforce