General Surgery at Rural Tennessee Hospitals: A Survey of Rural Tennessee Hospital Administrators

2011 ◽  
Vol 77 (7) ◽  
pp. 820-825
Author(s):  
Joseph B. Cofer ◽  
Tommy J. Petros ◽  
Hans C. Burkholder ◽  
P. Chris Clarke
Keyword(s):  
Rural Communities ◽  
National Survey ◽  
General Surgery ◽  
Response Rate ◽  
General Surgeon ◽  
Hospital Administrators ◽  
Surgical Services ◽  
Surgical Workforce ◽  
General Surgeons ◽  
The Mean

Rural communities face an impending surgical workforce crisis. The purpose of this study is to describe perceptions of rural Tennessee hospital administrators regarding the importance of surgical services to their hospitals. In collaboration with the Tennessee Hospital Association, we developed and administered a 13-item survey based on a recently published national survey to 80 rural Tennessee hospitals in August 2008. A total of 29 responses were received for an overall 36.3 per cent response rate. Over 44 per cent of rural surgeons were older than 50 years of age, and 27.6 per cent of hospitals reported they would lose at least one surgeon in the next 2 years. The responding hospitals reported losing 10.4 per cent of their surgical workforce in the preceding 2 years. Over 53 per cent were actively recruiting a general surgeon with an average time to recruit a surgeon of 11.8 months. Ninety-seven per cent stated that having a surgical program was very important to their financial viability with the mean and median reported revenue generated by a single general surgeon being $1.8 million and $1.4 million, respectively. Almost 11 per cent of the hospitals stated they would have to close if they lost surgical services. Although rural Tennessee hospitals face similar difficulties to national rural hospitals with regard to retaining and hiring surgeons, slightly more Tennessee hospitals (54 vs 36%) were actively attempting to recruit a general surgeon. The shortage of general surgeons is a threat to the accessibility of comprehensive hospital-based care for rural Tennesseans.

Current Trends in Surgical Procedures Performed in Rural General Surgery Practice

2020 ◽  
pp. 000313482094739
Author(s):  
Wade W. Stinson ◽  
Robert P. Sticca ◽  
Gary L. Timmerman ◽  
Paul M. Bjordahl
Keyword(s):  
Hernia Repair ◽  
Surgical Procedures ◽  
General Surgery ◽  
The United States ◽  
General Surgeon ◽  
Case Volume ◽  
Endoscopic Procedures ◽  
Surgical Workforce ◽  
Operative Case ◽  
General Surgeons

Background The procedures that rural general surgeons perform may be changing. It is important to recognize the trends and practices of the current rural general surgeon in efforts to better prepare general surgeons who desire to enter a practice in a rural environment. The aim of this review is to detail the recent operative case volumes of 6 rural locations in the upper Midwest where general surgery is practiced. Methods The Enterprise Data and Analytics department of Sanford Health compiled all surgical procedures performed within the Sanford Health System between January 1, 2013 and August 31, 2018. Procedures performed by a total of 58 general surgeons in locations of under 50 000 people are included in this review. Results From January 1, 2013 to August 31, 2018, 38 958 surgical procedures were performed in rural locations. Endoscopic procedures made up 61.6% of a rural general surgeon’s practice. Cholecystectomy (6.3%), hernia repair (6.3%), and appendectomy (3.7%) were the principle nonendoscopic procedures performed by rural surgeons, comprising 16.3% of the case volume. Added together, endoscopy, cholecystectomy, hernia repair, and appendectomy made up 77.9% of the rural general surgeon’s caseload. Vascular procedures (2.5%), breast procedures (1.8%), obstetrics (0.4%), and urology procedures (0.2%) are also included in this review. Conclusions Rural general surgeons are vital to the surgical workforce in the United States. Recognizing a trend that rural general surgeons perform less subspecialty procedures and more endoscopic procedures will provide direction for those interested in pursuing a career in rural general surgery.

Is Western Australia’s rural surgical workforce going to sustain the future? A quantitative and qualitative analysis

2017 ◽  
Vol 41 (1) ◽  
pp. 75 ◽  
Author(s):  
Sharanyaa Shanmugakumar ◽  
Denese Playford ◽  
Tessa Burkitt ◽  
Marc Tennant ◽  
Tom Bowles
Keyword(s):  
Western Australia ◽  
General Surgery ◽  
Hospital Staff ◽  
Published Data ◽  
Career Stage ◽  
Surgical Services ◽  
Rural Workforce ◽  
Surgical Trainees ◽  
Surgical Workforce ◽  
Rural Training

Objective Despite public interest in the rural workforce, there are few published data on the geographical distribution of Australia’s rural surgeons, their practice skill set, career stage or work-life balance (on-call burden). Similarly, there has not been a peer-reviewed skills audit of rural training opportunities for surgical trainees. The present study undertook this baseline assessment for Western Australia (WA), which has some of the most remote practice areas in Australia. Methods Hospital staff from all WA Country Health Service hospitals with surgical service (20 of 89 rural health services) were contacted by telephone. A total of 18 of 20 provided complete data. The study questionnaire explored hospital and practice locations of practicing rural surgeons, on-call rosters, career stage, practice skill set and the availability of surgical training positions. Data were tabulated in excel and geographic information system geocoded. Descriptive statistics were calculated in Excel. Results Of the seven health regions for rural Western Australia, two (28.6%) were served by resident surgeons at a ratio consistent with Royal Australasian College of Surgeons (RACS) guidelines. General surgery was offered in 16 (89%) hospitals. In total, 16 (89%) hospitals were served by fly-in, fly-out (FIFO) surgical services. Two hospitals with resident surgeons did not use FIFO services, but all hospitals without resident surgeons were served by FIFO surgical specialists. The majority of resident surgeons (62.5%) and FIFO surgeons (43.2%) were perceived to be mid-career by hospital staff members. Three hospitals (16.7%) offered all eight of the identified surgical skill sets, but 16 (89%) offered general surgery. Conclusions Relatively few resident rural surgeons are servicing large areas of WA, assisted by the widespread provision of FIFO surgical services. The present audit demonstrates strength in general surgical skills throughout regional WA, and augers well for the training of general surgeons. What is known about the topic? A paper published in 1998 suggested that Australia’s rural surgeons were soon to reach retirement age. However, there have been no published peer-reviewed papers on Australia’s surgical workforce since then. More recent workforce statistics released from the RACS suggest that the rural workforce is in crisis. What does this paper add? This paper provides up-to-date whole-of-state information for WA, showing where surgical services are being provided and by whom, giving a precise geographical spread of the workforce. It shows the skill set and on-call rosters of these practitioners. What are the implications for practitioners? The present study provides geographical workforce data, which is important to health planners, the general public and surgeons considering where to practice. In particular, these data are relevant to trainees considering their rural training options.

General surgery at rural hospitals: a national survey of rural hospital administrators

Surgery ◽  
2008 ◽  
Vol 143 (5) ◽  
pp. 599-606 ◽  
Author(s):  
Brit Doty ◽  
Randall Zuckerman ◽  
Samuel Finlayson ◽  
Paul Jenkins ◽  
Nathaniel Rieb ◽  
...  
Keyword(s):  
National Survey ◽  
General Surgery ◽  
Rural Hospitals ◽  
Rural Hospital ◽  
Hospital Administrators

scholarly journals SP4.1.4 Stay at home, protect the NHS, Save lives? The impact of the COVID-19 pandemic on acute surgical services

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Oliver Brewster ◽  
Dale Thompson ◽  
Emma Sewart ◽  
Sarah Richards
Keyword(s):  
Abdominal Pain ◽  
General Surgery ◽  
District General Hospital ◽  
Surgical Patients ◽  
Emergency Admissions ◽  
Emergency Operations ◽  
Surgical Services ◽  
The Mean ◽  
The Impact ◽  
Second Wave

Abstract Aims Several centres described a ‘lockdown effect’: a reduction in emergency surgical admissions during national lockdown (23/03/20-01/06/20). The extent and reproducibility of this is unclear. We evaluated the impact of the COVID-19 pandemic on emergency general surgical activity in a district general hospital. Methods We conducted a retrospective analysis of patients admitted under general surgery and urology between 01/01/2017-31/12/2020 using coding data. Unpaired t-tests were used to compare the total monthly admissions, admissions by diagnosis and monthly operations performed between the ‘first wave’ (April-May 2020) and ‘average’ (all months 2017-2019), and between the ‘second wave’ (November-December 2020) and average. Results Overall emergency admissions in 2020 were reduced compared to the mean 2017-2019 (4498 vs 5037). Monthly admissions were significantly reduced in the first wave compared to 2017-2019 (mean monthly admissions=284.5 vs 419.8; p < 0.001) with the greatest reduction in patients with non-specific abdominal pain (mean=58 vs 109; p = <0.001). A significant reduction in monthly admissions with pancreatitis (mean=8.0 vs 14.6; p = 0.010) and diverticulitis (mean=10.5 vs 18.8; p = 0.028) were also observed. This effect was less apparent during the second wave (mean total admissions=384.5 vs 419.8; p = 0.249). Monthly emergency operations were reduced in both the first wave compared to average (68 vs 101.9; p = 0.007) and the second wave (74.5 vs 101.9; p = 0.025). Conclusions We found strong evidence of a ‘lockdown effect’ in our centre during the first wave. The cause is unclear and likely to be multifactorial. Further research is needed to evaluate whether surgical patients came to harm as a result.

Article Commentary: Surgical Workforce in the American South

2011 ◽  
Vol 77 (2) ◽  
pp. 133-138 ◽  
Author(s):  
Anthony Charles ◽  
Katie Gaul ◽  
Stephanie Poley
Keyword(s):  
United States ◽  
General Surgery ◽  
Healthcare Access ◽  
Surgical Care ◽  
Population Expansion ◽  
The United States ◽  
General Surgeon ◽  
Successful Implementation ◽  
Surgical Access ◽  
Surgical Workforce

There exists a geographic maldistribution of surgeons with significant regional characteristics, which is associated with surgical access differentials that may be contributing to existing health disparities in the United States. We sought to evaluate the trends in the surgical workforce in southern states of the United States from 1981 to 2006 using the American Medical Association Masterfile data. Our study revealed that the general surgery workforce growth peaked in 1986 and has had negative growth per capita as a result of the consistent population growth, unlike other regions in the country. Furthermore, the change in the geographic distribution of general surgeons in the South was slightly greater than for surgical specialists between 1981 and 2006. Twenty-nine per cent of all southern counties with a collective population of 7.4 million people had no general surgeon in 2006. The failure of the general surgery workforce to grow with population expansion has resulted in a significant number of counties that do not meet the recommended standards of geographic access to surgical care. An adequate solution to surgical workforce demand is imperative for viable and successful implementation of healthcare reform, particularly in geographic regions with large healthcare access disparities.

scholarly journals TP8.2.30 Bleep paralysis: preventing inefficiency on the general surgical on-call

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Helen Whitmore ◽  
Rola Salem ◽  
Kirk Bowling ◽  
Holly Clamp ◽  
Rosaline Chandra ◽  
...  
Keyword(s):  
Junior Doctor ◽  
Single Point ◽  
House Officer ◽  
Referral System ◽  
Senior House Officer ◽  
Post Intervention ◽  
Constant Intensity ◽  
Surgical Services ◽  
Surgical Workforce ◽  
The Mean

Abstract Aims The demand on surgical services is increasing. In our Trust, all surgical referrals and queries are directed through the Senior House Officer (SHO) on-call. This leads to inefficiency, with many hours spent on the telephone and away from clinical duties. Such constant intensity can cause increased stress and anxiety amongst those involved. Junior doctor burnout and stress-related sickness are increasing concerns amongst the current surgical workforce. In an attempt to alleviate these factors, we instigated an intervention to evenly distribute workload during surgical on-calls. Method The number of bleeps through the surgical SHO on-call were audited for four consecutive thirteen hour shifts. Each call was estimated to take an average of five minutes to resolve. A separate GP referral phone was introduced to reduce the volume of traffic through the SHO bleep. The number of calls through the SHO and referral phone were re-audited following this intervention. Results Before introduction of a referral phone, the mean length of time spent by the SHO per shift answering calls was 232.5 minutes, with a maximum of 330 minutes. Post intervention, the SHO spent an average of 92.5 minutes per shift answering calls and referrals through the GP phone averaged 43.75 minutes. Conclusion The introduction of a single point GP referral system has significantly reduced the volume of calls through the SHO, thus has also minimised time spent away from on-call duties. Not only does this improve efficiency within the on-call team, but also reduces risk of burnout amongst trainees.

State of rural general surgery programs: A national survey of rural hospital administrators

2007 ◽  
Vol 205 (3) ◽  
pp. S76
Author(s):  
Nathaniel Rieb ◽  
Brit Doty ◽  
Steven Heneghan ◽  
Randall Zuckerman
Keyword(s):  
National Survey ◽  
General Surgery ◽  
Rural Hospital ◽  
Hospital Administrators

scholarly journals Will there still be a need for preparation in Gynecology and Obstetrics for the general surgeons and vice-versa?

2020 ◽  
pp. 34-35
Keyword(s):  
Clinical Practice ◽  
Digestive Tract ◽  
General Surgery ◽  
Surgical Intervention ◽  
Damage Control ◽  
General Surgeon ◽  
Cesarean Sections ◽  
Uterine Arteries ◽  
Gynecology And Obstetrics ◽  
General Surgeons

The development of the various surgical specialties and their respective training programs, together with some shortening in the duration of the residencies, has led to their separation from what we might call the mother speciality, General Surgery. In some cases, like Gynecology and Obstetrics, at least in my country, this has become total, with reflexes in the hospital clinical practice. Similarly, the training in General Surgery has been emptied from surgical exposure to other organs, systems and anatomical areas, with an increasing focus on digestive tract pathology and emphasis on laparoscopic approaches, which may make the general surgeon himself feel less prepared for acute gynecological or obstetric pathology. Although, in elective surgical practice, there tends to be an approach between the General Surgery and Gynecology teams, with the establishment of close collaborations, especially in the treatment of peritoneal dissemination of ovarian neoplasias, it is in the context of urgency that there is more to be done. In my case, during a clinical practice of more than 30 years as a general and emergency surgeon, it was not unusual to be called to operating rooms, sometimes peripheral, in the context of cesarean sections, to help solve complex situations, almost always of hemorrhagic nature. Among these, the lesions of the uterine arteries, during the incision of the uterus, and those of the inferior epigastric vessels, artery and veins, because of the retractors, especially in transversal incisions of the abdominal wall, these with the particularity of not being easily identifiable, because they produce essentially retroperitoneal bleeding, with a somewhat late clinical expression. Due, mainly, to the associated coagulopathy, it was necessary, many times, a strategy of damage control [2], with initial abbreviated surgical intervention. They are - without forgetting many others, like those of the digestive tract or ureters - situations of enormous gravity and in young women that should lead to a greater reflection from both sides; either on the part of obstetricians, in terms of reintroducing General Surgery training in their respective formative programs, or, vice versa, on the part of general surgeons linked to the emergency, not always familiar with them. [2] This strategy consists of an initial abbreviated surgical intervention, with the sole purpose of resolving hemorrhage and contamination; having started in abdominal trauma, it quickly spread out of the abdomen and the context of traumatic pathology.

THE Future Delivery of Emergency Surgery in the UK

2013 ◽  
Vol 95 (10) ◽  
pp. 324-328 ◽  
Author(s):  
CJ Lewis Consultant Surgeon ◽  
SE Attwood Consultant Surgeon
Keyword(s):  
Vascular Surgery ◽  
General Surgery ◽  
Breast Surgery ◽  
General Surgeon ◽  
Gi Tract ◽  
Oncoplastic Breast Surgery ◽  
The Past ◽  
General Surgeons ◽  
Traditional Sense ◽  
The Uk

Over the past two decades, general surgeons have evolved and subspecialised. It is no longer plausible for a consultant to label him or herself as a true general surgeon in the traditional sense of the term. For example, a surgeon is very unlikely to have the training and experience to operate on all aspects of the gastrointestinal (GI) tract while still maintaining adequate skills in oncoplastic breast surgery and vascular surgery. To maintain adequate skill and up-to-date knowledge, it has become necessary for surgeons to focus on one area of general surgery, declaring an interest in that subspecialty while continuing to serve as a general surgeon for the purposes of the emergency on-call provision for general surgery.

scholarly journals Characteristics of Horticultural Distribution Centers

1999 ◽  
Vol 17 (3) ◽  
pp. 134-136
Author(s):  
M.P. Garber ◽  
K. Bondari
Keyword(s):  
National Survey ◽  
Regional Differences ◽  
Response Rate ◽  
Full Time ◽  
Distribution Centers ◽  
Part Time ◽  
The Mean ◽  
Hourly Workers ◽  
Compensation Rate

Abstract A national survey of Horticultural Distribution Centers (HDCs) resulted in a 32.3% response rate with owners representing 68% of respondents. The greatest number of respondents were from the Northeast and firms have been in business from 3 to 115 years for an average of 26.5 years. About one-fourth of the firms surveyed (27.4%) were engaged only in distribution activity. However, for all firms, distribution activity accounted for over half (54.2%) of their revenue. The average HDC had annual revenue of $3.4M. The mean number of full-time employees was about 33, with an additional 16 part-time hourly. Average hourly compensation rate ranged form $15.67 for manager/supervisor to $10.58 for staff and $8.94 for full-time hourly workers. Data were analyzed by region of the country and regional differences are discussed.

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