Monday, July 6, 2015

What about a rural track surgical residency program?

Here's an email from someone interested in rural surgery:

I am a senior medical student planning on going in to general surgery and practicing in a moderate sized city (~70k people), but would also like to do some medical missions. I currently do not plan on doing a fellowship after residency, and would like to go directly into practice. I have seen a growing trend of "rural programs” popping up including Mayo starting a rural track this year, Wisconsin has one rural spot, and Gundersen is another notable program. For many of these programs you leave your primary training hospital during PGY3-4 and go train rural hospital, you may also spend more time doing OB/GYN cases or other surgical specialties. How do you think this affects the preparedness of the residents leaving these programs vs a community program with a high case load or university program? Most of these programs advertise all the “extra” skills acquired from participating in their rural tracks but don’t discuss what that means you will miss.

Great question. I have no personal experience with rural track surgical programs. From what I have read, most residents who go this route emerge satisfied.

I think you need to speak to a few residents who have done it and see if they feel they missed anything. It probably wouldn't be too hard to get some names from coordinators in programs that have the rural option.

My concern for your situation is that if you plan to practice in a city of about 70,000, it is highly unlikely that you will be doing C-sections, orthopedics, or G.I. endoscopy. This would negate much of the value of doing a rural track. I have a few former residents who practice in small towns and do C-sections and endoscopies, but those locations have fewer than 10,000 people. My program provided a decent endoscopy experience, but since we had an OB/GYN residency, I think my graduates learned to do C-sections after they left the program.

Since you are planning to practice in a community hospital, you may want to consider training in a busy community hospital residency program. The way things are going in general surgery, case volume is becoming more and more important. As a general surgeon in a city of 70,000, you will probably not be doing big cases such as Whipples and major vascular surgery anyway.

Can any of my readers offer you more advice?

10 comments:

frankbill said...

I have little knowledge of residency programs. I do however live in a rural area with major medical centers with in 100 miles of me that at least one of them may be part of the Mayo rural track program.

Perhaps this senior medical student could contact one of the three I have listed here. Dartmouth-Hitchcock Medical Center, The University of Vermont Medical Center or the Maine Medical Center.

Also many VA Medical Centers serve large rural areas.

artiger said...

Scalpel, I would concur, don't do the rural residency track if you're planning on practicing in that big of a place. I suppose that geography matters somewhat, as there might be isolated cities that have maybe 20,000 or so population, and some of the skills, particularly gynecology and limited orthopedics, might be of some value. It's going to be harder in the future for hospitals in those settings to recruit those specialties.

Skeptical Scalpel said...

Thanks for your comments.

Anonymous said...

I did a limited rural track and learned c sections, hysterectomies, ureteral catheters, and other things in uro and gyn... I didn't learn any ortho -- too different/hard. I agree probably not useful in most general surgery practices but I did learn some technical tips from the other specialties, and think it will be useful for missions. I don't feel I missed out on general surgery (2-3 months) but I am probably more of an active learner than most people and have probably put in more time than others...

frankbill said...

This site may be useful http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page

Anonymous said...

This is dr.muchogusto from twitter. I personally have no experience in surgical rural care and I am not training in a rural program. However, I plan on practicing in a rural med after Im done w my training. There is a surgeon on twitter who has been advising me, Hope Amantine. In fact she wrote a blog on rural surgical care based on my questions. I encourage anyone interested in surg rural med to read her blogs and to contact her if you have questions. She is really approachable and has been really helpful in guiding me. I believe she actively teaches surg res at her hosp, but she trained in a big city. I think she can explain pros/cons for training in big city vs rural. Good luck!
https://twitter.com/HopeAmantine
http://simplecountrysurgeon.blogspot.com/2015/05/the-bad-ugly-and-good.html

Skeptical Scalpel said...

This is very useful information. I have read some of Hope's posts. She's good. Thanks.

The Doctor Isn't In said...

I guess for me less is more. In surgery after doing it for 30 years I find that I focus more and avoid taking on everything simply because I "can" With liability as high an issue as it is the rural program is interesting and will serve you well for your mission trips but in reality you won't be called to do the cases you are hoping to learn about and those you do you will be held to the standards of the super specialists adjacent to you.
You are much better off getting LOTS of training rather then lots of areas of training. For me and my residents I tech focus focus focus not doing as much as you can in all aspects.

Skeptical Scalpel said...

The Doctor makes a very interesting and pertinent point.

artiger said...

Agreed, pretty good points. One thought I just had was that if a resident wanted to do several months out in a rural area, it might be best to do so late in residency. At that point, the resident's skill sets would be higher, and s/he may have fully decided on rural practice at that point (as opposed to doing a rural rotation during the more junior years). Maybe even a 3-6 month postgrad fellowship in rural surgery would be the answer.

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