Invited Commentary

Cleve Trimble, MD
Arch Surg. 1997;132(5):498. doi:10.1001/archsurg.1997.01430290044006.
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Landcasper et al conclude that selected procedural rotations will better prepare surgical residency graduates for rural practice. Not discussed, however, was the larger question of whether a young surgeon should choose such a setting in the first place. There are considerations beyond the idyllic notion that a surgeon can escape managed care by being versatile, to wit:

  • Rural surgery is solo, almost by definition; if a place has enough clinical work for 2, it is simply not "rural." To voluntarily separate oneself from colleagues and mentors is dangerous at any stage of a profession, let alone the outset.

  • Transition from the teaching institution's environment of technologic plenty (a dependency demanded by standards of care) to one of dearth puts inordinate pressure on a clinical acumen which is only developing. It requires a mature ego to realize that surgical capabilities are often determined not by one's training but by


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