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November 1997

Invited Commentary: Spectrum of General Surgery in Rural America

Author Affiliations

Alexander City, Ala [population, 14 917]

Arch Surg. 1997;132(11):1239. doi:10.1001/archsurg.1997.01430350089015

Landercasper et al1 provides an important description of general surgery in rural America. Their rural surgery case registry describes a caseload requiring flexible, capable, and broadly trained general surgeons. Dr Trimble, also from a small community (Norfolk, Nebraska; population, 21 476), in his invited commentary2 accompanying the article by Landercasper et al, decries that a finishing surgical resident should pursue a rural surgical career. His commentary on rural surgical practice included notions that "rural" means solo and isolated, clinical acumen is insufficient immediately following training, rural means low volume and results in skill decay, and work in such an environment means compromise vs competition with the primary care providers. Based on these notions, he advises finishing residents that "wisdom and vision would make it [rural surgical practice] their last job, not their first." Dr Trimble's wisdom and vision, based on his rural experience, does not accurately describe all

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