Department of Surgery, Oregon Health and Science University, Portland, Oregon.
JAMA Surg. 2013 Sep;148(9):817-21. doi: 10.1001/jamasurg.2013.2681.
Although 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.
To 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 PARTICIPANTS: In 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.
Age, sex, and initial practice plans.
Age, 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).
Providing 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.
尽管外科医生劳动力预测表明，对普通外科医生的需求增加，尤其是在农村地区，但住院医师培训项目的毕业生越来越多地进入城市或大都市的专业实践。
确定在农村环境中的医院的第四年住院医师是否更有可能进入普通外科实践而不是专业实践。
设计、地点和参与者：2002 年，我们启动了一项为期一年的第四年住院医师计划。自农村轮转开始以来，完成我们普通外科住院医师培训并进入实践的所有外科住院医师（n=70）的记录分为完成农村手术计划（农村）和未完成农村手术计划（其他）的记录。比较了两组的人口统计学特征和最初从事农村普通外科实践的意愿。关键终点包括完成奖学金、普通外科实践以及实践地点的人口少于 5 万。作为额外的对照组，我们比较了这些与我们的农村计划开始之前（1993-2002 年）完成住院医师培训的居民，比较了奖学金和实践特征。
年龄、性别和初始实践计划。
两组的年龄、性别和初始实践计划没有差异。完成农村年的居民更有可能从事普通外科实践（11 人中的 10 人[91%]），而未完成农村年的居民中只有 59 人中的 28 人（47%）；P=0.009）。他们也更有可能在人口少于 50000 的地点进行实践（4 名中有 11 人[36%]，而 59 名中有 4 人[7%]；P=0.02）。1993-2002 年和 2003-2012 年在俄勒冈健康与科学大学完成所有培训年的居民的实践类型和奖学金完成率没有差异。完成农村年的大多数居民（11 人中的 6 人[55%]）进入培训时希望从事普通外科。他们都在从事普通外科。在以专业生涯为目标进入培训的居民中，完成农村年的 5 人中的 4 人（80%）正在从事普通外科，而在整个 5 年期间留在我们大学项目中的 45 人中的 13 人（29%）正在从事普通外科实践（P=0.04）。
为住院医师提供在农村环境中专门且重要的经验，增加了他们在类似环境中从事普通外科实践的可能性，尽管最初有专业计划。实施此类计划可能有助于缓解小镇和农村医院劳动力需求日益增加的差距。
