Hospitals in a community of this size will have more surgical specialists and will usually have anesthesiologists on staff. At our hospital, we have an orthopedic service, urology, ophthalmology, podiatry, ob.gyn. physicians, and MD anesthesia. There are no gastroenterologists, ICU specialists, neurosurgeons, infectious disease specialists, ENT surgeons, vascular surgeons, thoracic surgeons, or other surgical subspecialists at our hospital.
With a larger medical staff and a more developed hospital infrastructure, rural surgeons in a large rural practice setting can take care of more varied and complex patients. In my practice, we do “bread and butter” elective cases as mentioned above. We also do thyroid surgery, carotid endarterectomies, carpal tunnel release, melanoma surgery, amputations, and we place dialysis catheters and subcutaneous ports, and cover the wound care clinic. In other large rural practice settings, surgeons may do tendon repairs, endoscopic retrograde cholangiopancreatography, salivary gland surgery, pediatric hernia repair, and non–cardiac thoracic surgery. Many medical communities of this size will not have a gastroenterologist on staff, so endoscopy is a large part of a rural surgeon’s practice in this setting also. In my practice, endoscopy accounts for 60% of our billing. There will be more general surgeons on staff in a large rural setting, so the call burden is not as pronounced. I have three partners, so I am on call one in four.
Rural surgeons in both small and large rural practices frequently will see urgent and emergent surgical problems and, in my mind, that’s where rural surgeons can make the most difference. In these situations, the rural surgeon will take care of whatever he/she and their hospital have the capability to do. Rural areas have no lack of trauma and sometimes, the care a rural surgeon provides can be lifesaving. Common urgent or emergency surgical cases include small- or large-bowel obstructions, diverticulitis, perforated ulcers, incarcerated hernia, and necrotizing fasciitis. Rural surgeons also play a vital role in stabilizing critically ill or injured patients prior to arranging for transfer to a larger center.
Rural surgeons have a very broad scope of practice, but that’s not because they think they’re good enough to “do it all.” They aren’t being “cowboy surgeons.” A good rural surgeon simply tries to utilize as many of the skills learned during residency to properly care for as many patients of the community as possible.
By working on the front lines, rural surgeons can make a very real difference for the patients of their communities. More to come in future columns!