Surgery Training for Rural America Fourth Rural Surgery Symposium May 17, 2009 David Borgstrom, MD, FACS Mary Imogene Bassett Hospital Cooperstown, New York Surgery in Rural America n What is rural? n Scope of the Problem n Possible Solutions What is Rural? n urban > 50,000 n large rural 10,000 to 50,000 n small rural 50 years old IMG earlier retirement n Solo practice continuing education vacation/call The Problem n economic issues lower reimbursement technology n liability issues increased cost costs of diversity n spouse/family concerns education/ culture/ diversity The Problem n Rural America deserves optimal care n surgery drives rural healthcare n workforce is diminishing n less interest among students and residents The Solution n Make it appealing n Training The Solution make it appealing n community/hospital commitment FP model in medical school n tuition payment n debt assumption Liability support n broad based care C-sections increased cost The Solution make it appealing n Provide support n technology laparoscopy radiology n nuclear medicine n mammography n teleradiology The Solution training n Medical education n GME n Post graduate education The Solution training n Medical education AAMC - Council on Graduate Medical Education (COGME) n 3,000 new medical students by 2015 increase class size new medical schools (very hard) affiliated campuses The Solution training n Rural residencies rural location rural tracks n reputation for rural connection residency lifestyle workforce preparation Surgery for Rural America n significant number in need surgeon numbers in decline n education reform different needs n national support/promotion n creativity to make it appealing partnership