Surgery Residents and Rural Health: Addressing the Needs of Rural Populations

The geographic distribution of physicians is a critical factor in addressing disparities in healthcare access, especially in rural and underserved areas. Rural surgeons address a crucial need for time-sensitive surgical interventions that might otherwise be unavailable locally, which otherwise would have significant transit time and yield negative outcomes. This recognition has led to specific rural tracks in general surgery residency training programs providing specialized care and training for physicians who need the tools necessary to care for these communities. Traditionally, osteopathic medical schools have emphasized preparing students to match into primary care specialties, including family medicine, internal medicine, pediatrics, and obstetrics. However, there is a lack of surgeons for both rural communities and urban populations. This study aims to explore the residency placement trends of osteopathic medical students, emphasizing their potential to fulfill the surgical needs of rural and underserved communities.


Methods or Case Description:

All general surgery residents training in the 2023-2024 academic year were identified from the most up-to-date residency program websites containing resident profiles. Information on residents’ degrees and the cities where their residency programs were located was collected. The classification of programs as urban or rural was based on two definitions. According to the US Census Bureau, cities with a population > 50,000 were considered urban, while those with a population < 50,000 were considered rural. The second definition followed a modified population approach, where the percentage of the population classified as rural was obtained from the Rural Health Information Hub (https://www.ruralhealthinfo.org/). The median value of these percentages was calculated, and cities with a rural population percentage above the 50th percentile were considered rural, while those below the 50th percentile were considered urban. The Mann-Whitney U test was used for statistical analysis, with a p-value < 0.05 considered significant.


Outcomes:

955 DO general surgery residents and 6225 MD general surgery residents were identified across 267 general surgery residency programs. Following the US Census Bureau definition for urban and rural populations, significantly more DO general surgery residents per program trained in rural areas compared to urban areas (mean: 5.02 vs. 3.12, p=0.0004). In contrast, significantly more MD general surgery residents per program trained in urban areas compared to rural areas (mean: 25.22 vs. 16.28, p=0.0002). The median percentage of the rural population at general surgery residency program sites was 3.4%. Significantly more DO general surgery residents per program trained in rural areas above the 50th percentile (mean: 3.96 vs. 3.194, p=0.0026), whereas more MD general surgery residents trained in rural areas below the 50th percentile (mean: 26.99 vs. 19.62, p=0.0009).



Conclusion:

An increasing number of osteopathic medical school graduates enter residency training programs every year, including general surgery and subspecialties. This study demonstrates the communities where osteopathic graduates are training and illustrates their role in rural community care. The data reveals a significantly higher number of osteopathic general surgery residents train in rural areas than their allopathic colleagues. However, further research is necessary to track the career trajectories of these residents post-training.