The declining number of general surgeons has precipitated a crisis in rural general surgery, but the degree to which access to surgical care in rural areas is affected has received limited attention. This study will examine the availability and content of surgical procedures in rural and urban areas as a function of surgeon supply, using surgeon supply data from the American Medical Association Physician Masterfile and inpatient procedure content data from the 2005 National Inpatient Sample of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. We will develop a novel typology of surgical procedures based on complexity, necessity, and urgency.

We posit that many rural areas lack general surgeons and that inpatient procedures in rural areas with low general surgeon supply will have relatively low complexity, but high necessity and high urgency (e.g., appendectomies). We will explore whether this relationship is influenced by patient sociodemographics and comorbidity, hospital factors, and per capita supply of other types of surgical specialists. Discerning patterns in procedural content across the rural-urban continuum nationally will enable policymakers and researchers to identify rural populations facing the greatest disparities in surgical access. Products will include a Final Report and Policy Brief on the WWAMI RHRC website. Findings will be presented at local, regional and national conferences and submitted for refereed publication.

Publications

• Variability in General Surgical Procedures in Rural and Urban U.S. Hospital Inpatient Settings
  Report
  WWAMI Rural Health Research Center
  Date: 03/2015
  This report addresses rural/urban differences in surgical practices in commonly performed inpatient surgical procedures that are typically handled by general surgeons. Findings indicate that rural hospitals concentrated on relatively common, low complexity procedures that can be handled by general surgeons.