I agree wholeheartedly with Dr Waddle's opening statement regarding the worldwide acceptance of the need for general surgeons in rural areas. In South Africa this issue has been widely debated, and numerous solutions have been proposed, including (1) specialist general surgeons whose postgraduate training incorporated a wide general, gynecological, obstetric, urological, orthopedic, and pediatric surgical skills base, (2) specialists in rural medicine (advanced comprehensive generalists) who need not be specialist surgeons, and (3) medical officers holding a 2-year diploma in general surgery. We have had much debate about the maldistribution of medical providers and wishful thinking regarding the creation of rural incentives to entice medical professionals away from financially rewarding and professionally satisfying urban tertiary medical centers. Recently, a compulsory year of community service in rural areas for physicians in their postinternship year has been implemented, but this only partially addresses one aspect of the problem. We need to create an attractive career structure not only to draw medical practitioners to rural areas but to enthuse them to remain in such employment, and better still to specialize in general surgery with the view to generalizing rather than acquiring certification in some surgical subspecialty.
Damp M. Rural Surgery—Invited Critique. Arch Surg. 2000;135(2):122. doi:10.1001/archsurg.135.2.122