Why Interested Surgeons Are Not Choosing Rural Surgery: What Can We Do Now?

Published:March 15, 2021DOI:



      There is a growing deficit of rural surgeons, and preparation to meet this need is inadequate. More research into stratifying factors that specifically influence choice in rural versus urban practice is needed.


      An institutional review board–approved survey related to factors influencing rural practice selection and increasing rural recruitment was distributed through the American College of Surgeons. The results were analyzed descriptively and thematically.


      Of 416 respondents (74% male), 287 (69%) had previous rural experience. Of those, 71 (25%) did not choose rural practice; lack of professional or hospital support (30%) and lifestyle (26%) were the primary reasons. A broad scope of practice was most important among surgeons (52%), who chose rural practice without any previous rural experience. Over 60% of urban practitioners agreed that improved lifestyle and financial advantages would attract them to rural practice. The thematic analysis suggested institutional support, affiliation with academic institutions, and less focus on subspecialty fellowship could help increase the number of rural surgeons.


      Many factors influence surgeons’ decisions on practice location. Providing appropriate hospital support in rural areas and promoting specific aspects of rural practice, including broad scope of practice to those in training could help grow interest in rural surgery. Strong collaboration with academic institutions for teaching, learning, and mentoring opportunities for rural surgeons could also lead to higher satisfaction, security, and potentially higher retention rate. These results provide a foundation to help focus specific efforts and resources in the recruitment and retention of rural surgeons.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Prepared for the AAMC by IHS Markit Ltd
        The complexities of physician supply and demand: projections from 2017 to 2033.
        Association of American Medical Colleges, Washington, D.C.2020
        • Rural Health Standing Committee
        National strategic framework for rural and remote health.
        Rural and Regional Health Australia, The Dept of Health, 2016 (Available at:)
        • McCarthy M.C.
        • Bowers H.E.
        • Campbell D.M.
        • Parikh P.P.
        • Woods R.J.
        Meeting increasing demands for rural general surgeons.
        Am Surg. 2015; 81: 1195-1200
        • Lynge D.C.
        • Larson E.H.
        • Thompson M.J.
        • Rosenblatt R.A.
        • Hart L.G.
        A longitudinal analysis of the general surgery workforce in the United States, 1981-2005.
        Arch Surg. 2008; 143: 345-350
        • Zastrow A.W.
        Dilemma of general surgery recruitment in rural America.
        World J Surg. 2006; 30: 269-270
        • Rosenblatt R.A.
        A view from the periphery, health care in rural America.
        N Engl J Med. 2004; 351: 1049-1051
        • Deveney K.
        • Deatherage M.
        • Oehling D.
        • Hunter J.
        Association between dedicated rural training year and the likelihood of becoming a general surgeon in a small town.
        JAMA Surg. 2013; 148: 817-821
        • Williamson Jr., H.A.
        • Hart L.G.
        • Pirani M.J.
        • Rosenblatt R.A.
        Rural hospital inpatient surgical volume: cutting edge service or operating on the margin?.
        J Rural Health. 1994; 10: 16-25
        • Rosenblatt R.A.
        • Hart L.G.
        Physicians and rural America.
        West J Med. 2000; 173: 348
        • Thompson M.J.
        • Lynge D.C.
        • Larson E.H.
        • Tachawachira P.
        • Hart L.G.
        Characterizing the general surgery workforce in rural America.
        Arch Surg. 2005; 140: 74-79
        • Taylor S.J.
        • Bogdan R.
        Introduction to qualitative research methods: a guidebook and resources.
        3rd ed. John Wiley and Sons, New York1998
        • Parikh P.P.
        • Brown R.
        • White M.
        • Markert R.J.
        • Eustace R.
        • Tchorz K.
        Simulation-based end-of-life care training during surgical clerkship: assessment of skills and perceptions.
        J Surg Res. 2015; 196: 258-263
        • Helland L.C.
        • Westfall J.M.
        • Camargo Jr., C.A.
        • Rogers J.
        • Ginde A.A.
        Motivations and barriers for recruitment of new emergency medicine residency graduates to rural emergency departments.
        Ann Emerg Med. 2010; 56: 668-673
        • Birch D.W.
        • de Gara C.J.
        The impact of a formal mentoring program for minimally invasive surgery on surgeon practice and patient outcomes.
        Am J Surg. 2007; 193: 589-592
        • Hancock C.
        • Steinbach A.
        • Nesbitt T.S.
        • Adler S.R.
        • Auerswald C.L.
        Why doctors choose small towns: a developmental model of rural physician recruitment and retention.
        Soc Sci Med. 2009; 69: 1368-1376
        • Stenger J.
        • Cashman S.B.
        • Savageau J.A.
        The primary care physician workforce in Massachusetts: implications for the workforce in rural, small town America.
        J Rural Health. 2008; 24: 375-383
        • Glasser M.
        • MacDowell M.
        • Hunsaker M.
        • et al.
        Factors and outcomes in primary care physician retention in rural areas.
        South Afr Fam Pract. 2010; 52: 336-340
        • Duffrin C.
        • Diaz S.
        • Cushion M.
        • Watson R.
        Factors associated with placement of rural primary care physicians in North Carolina.
        South Med J. 2014; 107
        • Valentine R.J.
        • Jones A.
        • Biester T.W.
        • Cogbill T.H.
        • Borman K.R.
        • Rhodes R.S.
        General surgery workloads and practice patterns in the United States, 2007 to 2009: a 10-year update from the american board of surgery.
        Ann Surg. 2011; 254: 520-526
        • Borman K.R.
        • Vick L.R.
        • Biester T.W.
        • Mitchell M.E.
        Changing demographics of residents choosing fellowships: longterm data from the american board of surgery.
        J Am Coll Surg. 2008; 206: 782-789
        • Kelley K.
        Good practice in the conduct and reporting of survey research.
        Int J Qual Health Care. 2003; 15: 261-266