An Examination of General Surgery Residency Programs with a Rural Track

BACKGROUND: There is a steady decline in the general surgery workforce in rural areas of the United States. In response, some surgery residency programs have devel-oped rural tracks to encourage rural practice and ade-quately prepare trainees for this setting. OBJECTIVE: To compare the practice type and location of graduates from general surgery residency programs with and without a dedicated rural track between 2011-2020. METHODS: General surgery residency programs with and without a rural track were identified using the Amer-ican Medical Association Residency and Fellowship Elec-tronic Interactive Database and the Rural Surgery Program list from the American College of Surgeons. Graduates of these programs who entered general sur-gery practice between 2011-2020 were subsequently identified from individual residency program websites and tracked to their current practice setting using a Goo-gle search of first and last name and residency affiliation. Practice location was identified by zip code or county name and coded by Rural-Urban Continuum Codes (RUCC, Economic Research Service, USDA). RESULTS: We identified 2,582 general surgery residency graduates from 2011 to 2020 across 66 residency pro-grams. Of these graduates from programs without a rural track, 23.6% entered general surgery practice without additional fellowship training, compared to 34.0% from residency programs with a rural track (p = 0.019). Com-munity or University-based program designation was not associated with decision to enter general surgery practice over fellowship training (p = 0.420). Proportion of graduates entering rural practice as defined by RUCC groups 7-9 was not associated with having a rural program track or with community or university-based pro-gram status. CONCLUSION: Residency programs with a rural track produce a higher proportion of graduates entering general surgery compared to fellowship, though they are no more likely than programs without a rural track to produce grad-uates who ultimately practice in rural areas. (C) 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Automated summary

This study compared the practice type and location of general surgery residency graduates with and without a dedicated rural track between 2011-2020. The results showed that residency programs with a rural track produced a higher proportion of graduates entering general surgery practice. However, there was no significant difference in the likelihood of graduates from programs with a rural track ultimately practicing in rural areas compared to programs without a rural track.