Otolaryngologic Emergencies
Rural surgeons frequently encounter airway issues, bleeding complications, and infections of the head and neck. Direct visualization of the airway improves diagnosis of airway obstruction as well as associated infections such as peritonsillar abscess, odo
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Rural Surgery Opportunity or Minefield
A
LTHOUGH theEnglish-
language literature is replete with articles concerning the need for general surgeons in rural areas, the methods of placement of interested residents in rural America has not been consistently addressed. Graduate surgical education has become a mill of specialists, but for those with a desire to generalize, an approved alternative form of training should be available. I would like to offer a resident’s perspective and suggestions for an alternative track in general surgery directed toward a career in rural surgery.
See Invited Critiques at end of article The impetus for my interest in rural surgery stemmed from an experience as a medical technologist working in remote southern Arizona for the Indian Health Service. For 5 years I assisted a broad spectrum of physicians moonlighting in an emergency department in Sells, Ariz. This experience ultimately inspired me to enter medical school. I continue to glean greater understanding about the delivery of health care from that remarkable experience. Most of the physicians I worked with were retired general practitioners who often spoke of the rigors of rotating internships, the need for broaderbased residencies, and the demands of private practice. From Bakelite thoracoplasty to cesarean sections, these retired general practitioners had done it all. After reaching retirement age (between 68 and 78 years), most practitioners continued to meet the demands of a busy rural emergency department. In retrospect, their experiences in training seem foreign to what I have been exposed to in both medical school and residency.
Like numerous medical students who are now otorhinolaryngology or orthopedic residents, I applied to medical school under the aegis of primary care. Nonetheless, the procedural-based medicine I experienced in Sells eventually directed me toward surgery. Currently as a surgical resident, I face the madding crowd’s descent into research and find myself questioning such intellectual indenturement and reevaluating my premedical ideals. Specialization is rampant, and the commitment to primary care and rural medicine needs to continue through postgraduate education. Rural opportunities abound and offer a unique way for a general surgeon to provide primary care. The need for rural surgeons has been reported at the international level. Canadian, Australian, and South African surgical societies have confronted the issue of rural surgery and begun to focus on rural surgery residency tracks. The Canadian problem has been described as “the urbanization of surgery” with the development of the attitude that it is “cheaper to have helicopter rescue teams than rural surgeons.”1(p12) Rural Canadian surgeons have directly addressed this callous mentality, but no entity exists that specifically trains surgeons for the rural environment.1-3 The Australian demand for rural surgeons has been scrutinized, and the Royal Australasian College of Surgeons has suggested that a 2-year fellowship be established.4 Some author
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