How much of other surgical specialties do general surgeons do in rural environments?

[Tullius]

For example, if a patient presents to the ED in a rural location with ruptured AAA, and this center has no vascular surgeon, would they wait for transport and hope the patient survives, or would a general surgeon do the emergent AAA repair?

[Edict]

On 3/5/2021 at 10:36 AM, Tullius said:

For example, if a patient presents to the ED in a rural location with ruptured AAA, and this center has no vascular surgeon, would they wait for transport and hope the patient survives, or would a general surgeon do the emergent AAA repair?

This would probably vary depending on if the surgeon was comfortable doing an emergent AAA repair or wanted to do it. If the surgeon wasn't comfortable or did not want to do it, they would send the patient to the nearest vascular surgeon. So to answer your question, this would really depend on local practice patterns which would be heavily dependent on the surgeon involved.

[1D7]

I'd assume most rural hospitals doesn't carry enough blood to keep the patient stable enough for the surgery. A rural hospital might not have anesthesiologist coverage either for intraop management. Plus with the proliferation of endovascular repair since the early 2000s, I imagine there have been fewer opportunities to keep their skills up with open repairs since most elective and ruptured AAA repairs probably get preferentially sent to the regional major centres for the option of endovascular repair.

I imagine the only reason a rural general surgeon would attempt a repair is if they were certain the patient would die during transport.

[jnuts]

Agree with the above that surgeons, especially new surgeons, are highly unlikely to operate outside her or his specialty ever.  Hate to say it, but this is one of those things that drives inequities between rural and urban populations.  

That said, the opportunities to do procedures outside your subspecialty, but within your specialty, is higher outside academic centers.  In Ortho for example, doing some joints and some sports.

 

[Snowmen]

I did my general surgery rotation in a relatively rural hospital (a roughly 250 beds regional referral center for specialized services but not an academic hospital). The general surgeons there did some procedures they wouldn't normally do in other centers like tracheotomies, pacemakers, etc.