The article on rural surgery by Waddle1 published in the ARCHIVES brings up many important issues. In reading the critiques, however, I thought an important point was missed: rural surgery as a concept has yet to be clearly defined. Such definition will require a study on the actual cost-effectiveness of rural surgery. I have practiced in small hospitals for many years, and I believe it is cost-effective. I believe that patients treated in my small hospital for many simple types of problems achieve equivalent results as patients who are cared for in larger hospitals, and they achieve these results at lesser cost and greater convenience. However, until this is proven, the rural surgeon will continue to be naked before the assault of the officially recognized specialty centers.
Morfesis FA. Defining Rural Surgery. Arch Surg. 2000;135(10):1231. doi:10.1001/archsurg.135.10.1231