Rural surgeons provide access to surgical care and serve a critical role in supporting primary care physicians and hospitals in the communities they treat. For decades, workforce analyses have suggested a crisis in access to surgical care in rural populations, with fewer and older surgeons working in rural areas.

A growing number of general surgery residencies are addressing these concerns by developing dedicated rotations and training tracks aimed at exposing trainees to rural surgery. In 2015, the WWAMI Rural Health Research Center identified nine general surgery programs that had a mission to produce rural physicians and required at least two months of rural training for some or all of their residents. A 2020 study found that 39 surgery programs had self-identified as having a rural track in the FREIDA™ residency database. And according to the RTT Collaborative, as of July 1, 2023, there were 5 accredited rural general surgery programs out of 362 programs with 17 active rural post-graduate year 1 positions, where a rural program is defined as having its primary hospital in a rural location according to two federal definitions, and residents spend more than 50% of their total time training in a rural place. Four of these programs were rurally located and one was a Rural Track Program (a designation of the Accreditation Council on Graduate Medical Education, ACGME), representing just 1% (17 of 1670) of all first-year positions offered in the General Surgery specialty in 2023 through the National Resident Matching Program.

These varied reports illustrate that, depending on the criteria, the number of programs providing rural general surgery training varies widely. Existing surgery program designs and strategies that residencies use to produce rural surgeons have not been well described, nor have their outcomes, including reducing the shortages of surgeons in rural areas. This study seeks to establish baseline knowledge on rural surgery training by answering these questions:

1. How many Rural Track Programs exist in general surgery, how many other programs offer dedicated rural rotations, and how many programs are in development?
2. What are the rural components of each type of program?
3. Does exposure to rural or community general surgery in each of these program types predict eventual practice in a rural environment, and how do their rural yields compare?
4. What are essential resources, barriers, and facilitators in implementing and sustaining rural general surgery residency programs?