Surgical practice in rural areas:
Gespeichert in:
| Weitere Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, PA
Saunders
2009
|
| Schriftenreihe: | Surgical clinics of North America
89,6 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIX S., S. 1279 - 1394 Ill., graph. Darst., Kt. |
| ISBN: | 1437713890 9781437713893 |
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Datensatz im Suchindex
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| adam_text | Titel: Surgical practice in rural areas
Autor: Zuckerman, Randall
Jahr: 2009
Surgical Practice in Rural Areas
Contents
Foreword xiii
Ronald F. Martin
Preface xv
Randall Zuckerman and David Borgstrom
Introduction xvii
George F. Sheldon
Rural Surgery: Framing the Issues 1279
Brit Doty and Randall Zuckerman
Many rural residents have limited access to surgical care. Although this
problem has been ongoing for the past few decades, several factors
threaten to exacerbate the situation. The narrowing of general surgery
practice, workforce shortages and inappropriate distribution of surgeons,
changes in how surgeons are trained, and increasing health care costs
contribute to the problem. Creative approaches to address these issues
are needed to provide high-quality surgical services to the approximately
50 million Americans living in rural communities.
Workforce Issues in Rural Surgery 1285
Dana Christian Lynge and Eric H. Larson
Almost one quarter of America s population and one third of its landmass
are defined as rural and served by approximately 20% of the nation s gen-
eral surgeons. General surgeons are the backbone of the rural health work-
force. There is significant maldistribution of general surgeons across
regions and different types of rural areas. Rural areas have markedly fewer
surgeons per population than the national average. The demography of the
rural general surgery workforce differs substantially from the urban general
surgery workforce, raising concerns about the extent to which general sur-
gical services can be maintained in rural areas of the United States.
Interdependence of General Surgeons and Primary Care Physicians
in Rural Communities 1293
Donald E. Pathman and Thomas C. Ricketts III
This article describes the unique roles and interrelations of general sur-
geons and primary care physicians in rural communities. It describes the
various ways in which the work and success of the rural surgeon and
the rural primary care physician rely on coordinating their efforts with the
Contents
other. It draws on available data, summary reports, and the authors per-
sonal experiences in rural practice and fifty years of combined experience
in research and policy analysis of rural health professions issues. Various
issues are discussed, including the specific and unique roles that rural sur-
geon need to play in rural health systems, the ways in which rural surgeons
relate to other physicians, and the likely consequences of not having prox-
imal surgical services.
Education for Rural Surgical Practice: The Oregon Health Science
University Model 1303
Karen Deveney and John Hunter
Physicians of all types are in short supply, with the shortage particularly
acute in primary care and general surgery. As the site of the only surgery
residency program in the state, Oregon Health Science University s De-
partment of Surgery has long been aware of the critical need for general
surgeons to provide emergency and elective surgical care for those who
live in remote areas and to support small rural hospitals whose survival de-
pends on the presence of a surgeon. Based on our experience over the
past 7 years, we believe that residents will benefit from a training program
that provides extensive exposure to procedures unique to a rural practice.
The objective of the training program is discussed in the article.
Rural General Surgery Training: The Gundersen Lutheran Approach 1309
Thomas H. Cogbill and Benjamin T. Jarman
This article outlines the approach taken at Gundersen Lutheran Medical
Foundation to prepare general surgery residents for rural general surgery
practice. The methods focus on strong core training in general and mini-
mally invasive surgery, additional technical skill sets, rural surgery electives,
outcomes-based research experience, practice management education,
and maintenance of relationships with graduates after residency.
Education of the Rural Surgeon: Experience from Tennessee 1313
W. Heath Giles, Joshua D. Arnold, Thomas S. Layman, Michael P. Sumida,
Preston W. Brown, R. Phillip Burns, and Joseph B. Cofer
The rural surgery rotation that is contained within the general surgery res-
idency program at The University of Tennessee College of Medicine-Chat-
tanooga is described in this article. The advantages of this experience,
including the extensive endoscopy experience and the close exposure
to practicing general surgeons, are also outlined. The rotation receives uni-
formly positive evaluations from residents at completion, and it has be-
come the primary gastrointestinal endoscopy educational experience in
this program. The description serves as a model that can be used by other
programs to construct a rural surgery rotation.
Bassett Healthcare Rural Surgery Experience 1321
David C. Borgstrom and Steven J. Heneghan
The surgical training at Bassett is naturally broader than in many university
settings, with a survey showing that nearly 70% of graduates who practice
Contents
general surgery remain in a rurally designated area. Rural surgery experi-
ence falls into 3 categories: undergraduate, graduate, and postgraduate.
The general surgery training program has no competing fellowships or
subspecialty residencies; residents get significant experience with endos-
copy; ear, nose, and throat; plastic and hand surgery; and obstetrics and
gynecology. The rural setting lifestyle is valued by the students, residents,
and fellows alike. It provides an ideal setting for recognizing the specific
nuances of small-town American life, with a high-quality education and
surgical experience.
Rural Surgery: The Australian Experience 1325
Martin H. Bruening and Guy J. Maddern
A significant proportion of the Australian population resides nonmetropol-
itan regions. For the majority of these smaller regional centers, the surgical
service delivery has been traditionally provided by either solo or two-per-
son surgical practices. As medical students interest in rural practice de-
clined, new models were created to ensure medical care in these areas.
This article outlines the past and current state of medical care in rural
areas, highlighting models used in Port Augusta, Mount Gambier, and
Port Lincoln. It concludes that these models are successful and should
be further developed.
Surgery in Remote and Rural Scotland 1335
Andrew J.W. Sim, Fiona Grant, and Annie K. Ingram
Over the past 15 years, rural surgery in Scotland has emerged from the
backwaters of the Scottish Health service to a recognized and important
part of overall health care provision in Scotland. No longer is the rural sur-
geon regarded by his city colleague as the eccentric poor relation of the
urban specialist. The rural surgeon is now more likely to have the skills
and experience necessary for the work that must be done. Training path-
ways are defined to ensure succession planning. The support of the Scot-
tish Government, Health Boards, and the Royal Colleges has been
essential; their continued involvement will ensure safe surgery for those
who dwell in the more isolated areas of Scotland.
Building and Maintaining a Successful Surgery Program in Rural Minnesota 1349
Howard M. McCollister, Paul A. Severson, Timothy P. LeMieur,
Shawn A. Roberts, and Mark W. Gujer
For decades, it has been axiomatic that rural health care systems are cru-
cial factors not only in the health of the populations that they serve but also
in the viability of America s rural communities. Medical care, as it is deliv-
ered in rural America, is becoming increasingly problematic as national
health care delivery models evolve. Increasing reimbursement pressures
and changing practitioner lifestyle expectations have had negative effects
on rural communities and resulted in rural hospital closings and a declining
level of surgical care available. These two factors are interrelated, given the
importance of surgical services to the revenue stream of any hospital.
Contents
Rural Surgical Practice: An Iowa Group Model 1359
Timothy A. Breon
The general surgery workforce has been well characterized recently but
few recommendations have been offered to help make the practice of gen-
eral surgery in rural areas more attractive. This article describes how Iowa
Rural Surgical Associates, a group practice, was developed to meet the
surgical needs of three rural communities in southeast Iowa. Developing
the group resulted in a system of surgical delivery improving patient care
in the area and quality of life for the group s surgeons.
Rural Surgery: The North Dakota Experience 1367
David. R. Antonenko
Surgeon availability is a problem for small and isolated rural areas. Unless
the supply of surgeons trained for rural areas increases, patient care will be
jeopardized. Nationally, a diminishing number of graduating residents opt
for careers in general surgery. This crisis is unrecognized or ignored by
major teaching programs. This article describes a program at the Univer-
sity of North Dakota that allows exposure to surgical specialties by incor-
porating them into the general surgical services. It concludes that distinct
training for urban and rural general surgeons must be recognized; and gen-
eral surgery programs should be allowed to be innovative and not penal-
ized for adjusting their programs to allow residents to train for rural and
community sites.
Assessing and Improving the Quality of Surgical Care in Rural America 1373
Samuel R.G. Finlayson
The quality of surgical care in rural hospitals is important, as surgery re-
mains a critical component of rural health care systems. Current models
for surgical quality assessment and improvement largely reflect the char-
acteristics of larger urban hospital settings, which include proximity to
other providers for peer review, higher procedure volumes to accurately
assess outcomes, and greater financial resources to acquire data collec-
tion systems and finance participation in regional or national quality im-
provement programs, such as the American College of Surgeons
National Surgical Quality Improvement Program. Although rural surgeons
and hospitals face numerous challenges in their efforts to demonstrate
or improve the quality of their surgical practices, developments in surgical
quality favor their increased participation in quality improvement initiatives.
General Surgery Contributes to the Financial Health of Rural Hospitals
and Communities 1383
Brit Doty, Steven Heneghan, and Randall Zuckerman
Rural hospitals and communities often profit from the ability to provide sur-
gical services. There can also be substantial financial costs for individuals,
hospitals, and communities associated with not having access to surgical
Contents
care in rural areas. Despite these advantages, limitations that include
a shortage of rural general surgeons and other surgical staff and financial
constraints prevent some rural institutions from offering surgical services.
Few concrete data are available on this subject, and more research is
needed to confirm anecdotal reports regarding the positive economic im-
pact derived from general surgical services. It is especially important to ex-
amine and quantify the direct and indirect financial contribution that
a general surgeon makes to a rural hospital and community.
Index 1389
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| spelling | Surgical practice in rural areas guest ed. Randall Zuckerman ... Philadelphia, PA Saunders 2009 XIX S., S. 1279 - 1394 Ill., graph. Darst., Kt. txt rdacontent n rdamedia nc rdacarrier Surgical clinics of North America 89,6 General Surgery Rural Health Services Zuckerman, Randall (DE-588)140283196 edt Surgical clinics of North America 89,6 (DE-604)BV000003239 89,6 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=018859494&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Surgical practice in rural areas Surgical clinics of North America General Surgery Rural Health Services |
| title | Surgical practice in rural areas |
| title_auth | Surgical practice in rural areas |
| title_exact_search | Surgical practice in rural areas |
| title_full | Surgical practice in rural areas guest ed. Randall Zuckerman ... |
| title_fullStr | Surgical practice in rural areas guest ed. Randall Zuckerman ... |
| title_full_unstemmed | Surgical practice in rural areas guest ed. Randall Zuckerman ... |
| title_short | Surgical practice in rural areas |
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| topic | General Surgery Rural Health Services |
| topic_facet | General Surgery Rural Health Services |
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