Rural Surgery

[AB27]

Trying to feel out whether practicing in a more rural location/outside the major city centres would be viable as I am sick of the city lol. Which surgical specialties are suited to rural practice? How does the scope of practice differ in rural areas? Is pay different? Ty

[Edict]

20 minutes ago, AB27 said:

Trying to feel out whether practicing in a more rural location/outside the major city centres would be viable as I am sick of the city lol. Which surgical specialties are suited to rural practice? How does the scope of practice differ in rural areas? Is pay different? Ty

How rural are you talking about? 10k cities, 50k cities, 100k cities? 

General surgery, OB/GYN and orthopedics are the obvious choice with coverage available in most if not all hospitals, but you'll find specialties like ophtho, ent, urology in slightly larger cities around 50k and you'll probably find plastics, vascular in some of these cities 50-100k but not all. The most urban oriented surgical specialties are probably neuro, cardiac, vascular, thoracic and subspecialty general (hpb, surg onc, trauma) where you won't see them unless you are in a 150k+ cities with some catchment area. 

Scope of practice is generally wider in rural areas, i'm not probably the most qualified to speak on this but my very limited experience suggests that surgeons are able to do things they feel comfortable doing but aren't explicitly within their core sent of competencies (i.e. a general surgeon doing a pacemaker or a fem fem bypass (but also these surgeons tend to be older who trained doing these procedures)) and always have the option of referring out cases that aren't explicitly within their scope of practice and generally any truly complex case (especially one where monitoring and other peri-op specialists are needed) would be referred out. 

 

[AB27]

16 hours ago, Edict said:

How rural are you talking about? 10k cities, 50k cities, 100k cities? 

 

I'm thinking between 50 and 100k and away from large cities or larger but northern. In order to do work at more rural hospitals (while working mainly in a larger town) would you have to have a general/ OB/ortho residency? Or could a more specialized surgeon (eg vascular) still help out?

[zoxy]

3 hours ago, AB27 said:

Or could a more specialized surgeon (eg vascular) still help out?

I don't think there would be enough cases to sustain a vascular surgeon in a town of 50K-100K. There's something like 220 vascular surgeons in all of Canada. Some back of the envelope calculations gives you something like 160,000 patients per vascular surgeon. You could probably "help out" but I don't think there's enough cases to sustain a decent practice. Especially now that vascular surgeons don't have 5 years of General Surgery training and can't take Gen Surg cases and call.

It might be possible if the town had a much larger catchment area but I think vascular is too specialized for a regular 50K-100K town. Even the, I'm not sure a smaller hospital would have the equipment needed for more advanced vascular procedures that require endovascular suites. You'd be stuck in a stone-age practice doing just open procedures. Cardiac is out of the question. I think in addition to GenSurg, ObsGYn, Opthalmology, and Ortho; Urology and maybe ENT could be possible in a town of 50-100K.

 

[AB27]

 

37 minutes ago, zoxy said:

I don't think there would be enough cases to sustain a vascular surgeon in a town of 50K-100K. There's something like 220 vascular surgeons in all of Canada. Some back of the envelope calculations gives you something like 160,000 patients per vascular surgeon. You could probably "help out" but I don't think there's enough cases to sustain a decent practice. Especially now that vascular surgeons don't have 5 years of General Surgery training and can't take Gen Surg cases and call.

It might be possible if the town had a much larger catchment area but I think vascular is too specialized for a regular 50K-100K town. Even the, I'm not sure a smaller hospital would have the equipment needed for more advanced vascular procedures that require endovascular suites. You'd be stuck in a stone-age practice doing just open procedures. Cardiac is out of the question. I think in addition to GenSurg, ObsGYn, Opthalmology, and Ortho, Urology and maybe ENT could be possible in a town of 50-100K.

 

Ah I saw Peterborough and Sudbury have vascular programs and got hopeful haha

[zoxy]

37 minutes ago, AB27 said:

 

Ah I saw Peterborough and Sudbury have vascular programs and got hopeful haha

Sudbury is 160K and has a much bigger catchment area. It's catchment area that is important, not the actual population of the town. Sudbury would be the cardiovascular centre for Timmins, North Bay, Sault St.Marie, and most of North West Ontario. Surprised a bit about Peterborough though. Maybe because 1 in 4 of the population is over 65 they need vascular coverage? I wonder if they're older vascular surgeons who also trained in Gen Surg and they do some Gen Surg as well.

[AB27]

27 minutes ago, zoxy said:

I wonder if they're older vascular surgeons who also trained in Gen Surg and they do some Gen Surg as well.

From what I can tell 2/4 did the 0+5 and the other 2 finished med school in the 2000s so not thaaat old. Surprised me too as someone who lived there during undergrad does not seem like the sort of place to have a lot of resources 

[Edict]

11 hours ago, AB27 said:

I'm thinking between 50 and 100k and away from large cities or larger but northern. In order to do work at more rural hospitals (while working mainly in a larger town) would you have to have a general/ OB/ortho residency? Or could a more specialized surgeon (eg vascular) still help out?

In the US you can but in Canada surgeons tend to be based at a single site and have the patient referred to them. You can probably find some 50-100k towns that have a vascular surgeon. Certainly 100k+ is more likely to have them but not impossible. 

[premed72]

Related question: Just curious what surgical job prospects are like in towns/cities (and surrounding areas) such as Bolton, Nobleton, Caledon, King, Newmarket, Stoufville etc. - im mostly thinking Gen Surg for example. Is it difficult to find jobs in these areas? 

[Edict]

On 1/14/2022 at 12:15 AM, premed72 said:

Related question: Just curious what surgical job prospects are like in towns/cities (and surrounding areas) such as Bolton, Nobleton, Caledon, King, Newmarket, Stoufville etc. - im mostly thinking Gen Surg for example. Is it difficult to find jobs in these areas? 

I'd imagine with some connections or electives you could find a job there but I wouldn't say jobs are up for grabs in that area, still too close to Toronto to not be saturated.