• Karen Deveney, Mark Deatherage, David Oehling, and John Hunter.
• Department of Surgery, Oregon Health and Science University, Portland, Oregon.
• JAMA Surg. 2013 Sep 1; 148 (9): 817-21.

ImportanceAlthough projections of surgical workforce predict an increased need for general surgeons, especially in rural areas, graduates of residency programs increasingly enter urban or metropolitan specialty practice.ObjectiveTo determine whether fourth-year residents at a hospital in a rural setting were more likely to enter general surgery practice than a specialty.Design, Setting, And ParticipantsIn 2002, we initiated a year-long program for fourth-year residents. The records of all surgical residents (n = 70) who completed our general surgical residency and entered practice since the rural rotation began were divided into those completing the rural surgery program (rural) and those who did not (other). Demographic characteristics of the 2 groups and initial intent to practice rural general surgery were compared. Critical end points included completion of a fellowship, general surgery practice, and practice setting population of less than 50,000. As an additional control group, we compared these residents with those who completed residency just before our rural program began (1993-2002) with regard to fellowship and practice characteristics.Main Outcomes And MeasuresAge, sex, and initial practice plans.ResultsAge, sex, and initial practice plans of the 2 groups did not differ. Residents who completed the rural year were more likely to enter general surgery practice (10 of 11 [91%]) than those who did not (28 of 59 [47%]; P = .009). They were also more likely to practice in a site of population less than 50,000 (4 of 11 [36%] vs 4 of 59 [7%]; P = .02). The practice type and fellowship completion rate of the residents who finished all training years at Oregon Health and Science University during 1993-2002 and 2003-2012 did not differ. Most residents who completed the rural year (6 of 11 [55%]) entered residency with a desire to practice general surgery. All of them are practicing general surgery. Of the residents who entered training with a specialty career in mind, 4 of 5 (80%) who completed the rural year are practicing general surgery, while only 13 of 45 (29%) who stayed at our university program for the entire 5 years are in general surgery practice (P = .04).Conclusions And RelevanceProviding residents a dedicated and significant experience in a rural setting increases the likelihood that they will practice general surgery in a similar setting despite initial specialty plans. Implementing such programs might help alleviate the increasing gap in workforce needs of small towns and rural hospitals.

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