Department of Population Health, School of Medicine, University of Kansas, Salina, KS 67401, USA.
Department of Surgery, School of Medicine, University of Kansas, Salina, KS 67401, USA.
Rural Remote Health. 2024 Jan;24(1):8363. doi: 10.22605/RRH8363. Epub 2024 Jan 2.
Rural areas worldwide face a general surgeon shortage, limiting rural populations' access to surgical care. While individual and practice-related factors have been well-studied in the US, we need a better understanding of the role of community characteristics in surgeons' location choices. This study aimed to understand the deeper meanings surgeons associated with community characteristics in order to inform efforts spanning the rural surgeon workforce pathway, from early educational exposures, and undergraduate and graduate medical education, to recruitment and retention.
We conducted a qualitative, descriptive interview study with general surgeons in the Midwestern US about the role and meaning of community characteristics, exploring their backgrounds, education, practice location choices, and future plans. We focused on rural surgeons and used an urban comparison group. We used convenience and snowball sampling, then conducted interviews in-person and via phone, and digitally recorded and professionally transcribed them. We coded inductively and continued collecting data until reaching code saturation. We used thematic network analysis to organize codes and draw conclusions.
A total of 37 general surgeons (22 rural and 15 urban) participated. Interviews totaled over 52 hours. Three global themes described how rural surgeons associated different, often deeper, meanings with certain community characteristics compared to their urban colleagues: physical environment symbolism, health resources' relationship to scope of practice, and implications of intense role overlap (professional and personal roles). All interviewees spoke to all three themes, but the meanings they found differed importantly between urban and rural surgeons. Physical landscapes and community infrastructure were representative of autonomy and freedom for rural surgeons. They also shared how facilities, equipment, staff, staff education, and surgical partners combined to create different scopes of practice than their urban counterparts experienced. Often, rural surgeons found these resources dictated when they needed to transfer patients to higher-acuity facilities. Rural surgeons experienced role overlap intensely, as they cared for patients who were also friends and neighbors.
Rural surgeons associated different meanings with certain community characteristics than their urban counterparts. As they work with prospective rural surgeons, educators and rural communities should highlight how health resources can translate into desired scopes of practice. They also should share with trainees the realities of role overlap, both how intense and stressful it can be but also how gratifying. Educators should include the rural social context in medical and surgical education, looking for even more opportunities to collaborate with rural communities to provide learners with firsthand experiences of rural environments, resources, and role overlap.
全世界的农村地区都面临着普通外科医生短缺的问题，这限制了农村人口获得外科护理的机会。虽然在美国，个人和实践相关因素已经得到了很好的研究，但我们需要更好地了解社区特征在外科医生选址中的作用。本研究旨在了解外科医生与社区特征相关的更深层次含义，以便为跨越农村外科医生劳动力途径的各个方面提供信息，包括早期教育暴露、本科和研究生医学教育、招聘和留用。
我们对美国中西部的普通外科医生进行了一项定性、描述性的访谈研究，探讨了社区特征的作用和意义，研究内容包括他们的背景、教育、实践地点选择和未来计划。我们专注于农村外科医生，并使用了城市对照组。我们采用了便利抽样和滚雪球抽样，然后进行了面对面和电话访谈，并对访谈进行了数字记录和专业转录。我们进行了归纳式编码，并继续收集数据，直到达到编码饱和。我们使用主题网络分析来组织代码并得出结论。
共有 37 名普通外科医生（22 名农村医生和 15 名城市医生）参与了研究。访谈总计超过 52 小时。三个总体主题描述了农村外科医生与城市同事相比，如何对某些社区特征产生不同的、往往更深层次的含义：物理环境象征意义、卫生资源与执业范围的关系以及强烈角色重叠的影响（专业和个人角色）。所有受访者都谈到了这三个主题，但城乡外科医生对这些主题的理解有很大的不同。物理景观和社区基础设施对农村外科医生来说代表着自主和自由。他们还分享了设施、设备、人员、人员教育和手术合作伙伴如何结合起来，创造出与他们在城市中所经历的不同的执业范围。通常，农村外科医生发现这些资源决定了他们何时需要将患者转移到更高危的医疗机构。农村外科医生经历了强烈的角色重叠，因为他们照顾的患者也是他们的朋友和邻居。
农村外科医生与城市同行相比，对某些社区特征有不同的含义。在与未来的农村外科医生合作时，教育工作者和农村社区应该强调卫生资源如何转化为理想的执业范围。他们还应该向学员们分享角色重叠的现实情况，包括其强烈程度和压力，以及其令人满意的程度。教育工作者应该将农村社会背景纳入医学和外科学教育中，寻找更多的机会与农村社区合作，为学习者提供农村环境、资源和角色重叠的第一手体验。
