Dr Waddle has provided a thoughtful review of a situation that is becoming of increasing concern; ie, the declining number of rural surgeons. He does not define "rural," but for convenience we will describe a rural community as one of 10,000 or less. In Canada, we are faced with the same problem. Rural surgeons are retiring or nearing retirement age and are not being replaced by younger surgeons. There are several reasons for this. The current training programs in surgery do not include the more broadly based curricula of 20 to 30 years ago, and surgeons do not acquire skills in fracture management, skin grafting, urologic procedures, and gynecological/obstetrical operations. There is a tendency for younger surgeons to practice in groups, which allows them to spend less time on call and have more time for home life and other amenities.