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GENERAL SURGERY TRAINING FOR RURAL PRACTICE: EVOLUTION OVER SIX YEARS

GENERAL SURGERY TRAINING FOR RURAL PRACTICE: EVOLUTION OVER SIX YEARS. Karen Deveney, M.D. Oregon Health & Science University Portland, Oregon. DEMOGRAPHICS OF OREGON. 9 th largest geographic area of US states 3.79 million people ¾ of population lives in “I-5 corridor”.

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GENERAL SURGERY TRAINING FOR RURAL PRACTICE: EVOLUTION OVER SIX YEARS

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  1. GENERAL SURGERY TRAINING FOR RURAL PRACTICE:EVOLUTION OVER SIX YEARS Karen Deveney, M.D. Oregon Health & Science University Portland, Oregon

  2. DEMOGRAPHICS OF OREGON • 9th largest geographic area of US states • 3.79 million people • ¾ of population lives in “I-5 corridor”

  3. INITIAL IMPETUS TO DEVELOP PROGRAM-1990’s • Requests to Program Director and Chair from rural surgeons seeking partners and/or replacements • OHSU School of Medicine curriculum revision, addition of rural clerkship in family medicine

  4. NEEDS ASSESSMENT • Survey of all surgeons practicing 10 or more miles from a population center of 30,000 or more • Age of surgeons • Future plans • Spectrum of cases done • What they wish they’d learned in residency

  5. RESULTS • Average age 47 (30-71) • Mean of 15 years in practice • 78% felt training should be widened for optimal rural practice • Most needed skills: GYN, endoscopy, trauma; ortho, urology, ENT basics

  6. CHALLENGES TO ESTABLISHING A RURAL SURGERY EXPERIENCE • “Turf” issues (unwillingness of specialists to train their competition) • Funding the program • Finding a setting that is rural, but not so rural that the resident won’t see adequate volume

  7. OHSU ANSWER: THREE RIVERS COMMUNITY HOSPITALGRANTS PASS, OR • In a community of 23,000, 3.5 hours south of Portland, with a “rural feel”; forests, a wild and scenic river, outdoor activities • A high-quality hospital and ambulatory surgery center • Seven board-certified general surgeons and specialists in gynecology, orthopedics, urology, and otolaryngology, all eager to mentor a senior surgical resident • A supportive hospital administration

  8. RURAL SURGERY EXPERIENCE:ADMINISTRATIVE DETAILS • One year “immersion” experience at PGY-4 level • Living quarters available, suitable for a small family • Affiliation agreement with OHSU • Resident has equivalent salary and benefits • Complies with all ACGME policies and procedures

  9. RURAL SURGERY EXPERIENCE:SCHEDULE • 6 months general surgery (includes general, vascular, thoracic, endoscopy) • 1.5 months urology • 1.5 months gynecology • 1.5 months otolaryngology • 1.5 months orthopedics

  10. RURAL SURGERY EXPERIENCE:ANCILLARY BENEFITS • Models what practice will be like • Working with partners • Interacting with referring MD’s and consultants • Practice and office management • Billing • Better continuity of care than in most residency programs

  11. HISTORY OF OHSU RURAL PROGRAM-INITIAL YEARS 2003-2004: “Pilot” year-resident who grew up in Grants Pass 2004-2005: Elective year for one resident with interest in rural practice • Initial attempts to obtain RRC approval for year to “count” as a year of residency 2005-2006: Elective year for two residents • RRC unwilling to approve a “rural track” • Reapplication for Three Rivers as a site of training

  12. HISTORY OF OHSU RURAL PROGRAM-CURRENT STATUS 2006-2007: Elective year for two residents • RRC approves Three Rivers as site of training for one resident, subject to review and progress report October, 2008: First “official” rural resident passes ABS exams February, 2009: RRC approves progress report and request for the experience of both residents to count as a residency year

  13. RESIDENT EXPERIENCE AT THREE RIVERS • > 400 major cases • > 200 minor procedures and endoscopy • Basic and emergency procedures and rotations in ortho, ob/gyn, ENT, urology • Teleconferences from OHSU • Online learning • Local M&M and Journal Club

  14. SUMMARY OF OHSU RURAL SURGERY EXPERIENCE • 10 residents have completed the year at Three Rivers from 2003-present • 4/10 are still in residency • 3/10 went directly into clinical practice, two in small rural and one in large rural setting • 3/10 did fellowships, but joined community practices. Two of these have general surgery as part of their practice

  15. LESSONS LEARNED • In spite of a broad, enriched clinical surgical experience in a rural setting, not all residents will enter rural practice • The allure of specialist practice and influence of tertiary-care professors may be hard to overcome

  16. FUTURE DIRECTIONS • Identify site(s) and funding for shorter elective rotations • Develop debt repayment programs for defined length of practice in rural hospitals • Improve support by academic centers for rural surgeons: respite through locum tenens programs, advanced training in new procedures

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