Rural Surgery Training Program

Barclay Stewart, MD, PhD, MPH
Assistant Professor
Division of Trauma, Burn & Critical Care Surgery

Dana Lynge, MD
Associate Professor
VA Puget Sound Health Care System

UW Department of Surgery and UW Program for Global and Rural Surgery (UW PROGRESS) are thrilled to announce a new rural surgery training program in partnership with Billings Clinic in Billings, Montana: the Billings-UW Rural Surgery Track.

Rural America encompasses 72% of the nation’s land mass and is home to 46 million people (15% of the U.S. population). Dr. Dana Lynge (UW Associate Professor of Surgery based at VA Puget Sound Health Care System) and his colleagues found that the ratio of general surgeons per 100,000 population was 5.85 in urban counties and 4.31 in small rural counties. A more recent survey of rural hospital administrators by Doty and colleagues reported that 34% of rural hospitals had a surgeon leaving within the next two years and more than one-third of rural hospitals were searching for a surgeon. Similarly, Belsky et al. found that 30% of U.S. counties were without a surgeon. Of those counties without a surgeon, 50% had a hospital otherwise capable of providing surgical services. In addition to the rural surgical workforce shortfall in absolute terms, there is a deficiency in expertise regarding the breadth of surgical care required for practice in rural communities and ways to address the unique challenges intrinsic to rural health systems.

UW Department of Surgery is committed to serving the Washington, Wyoming Alaska, Montana and Idaho (WWAMI) region and addressing this growing national problem by training the next generation of surgeons capable of practicing in rural America and making meaningful, positive differences in the health of people living in rural communities. Additionally, many of the challenges faced by surgeons in rural practice are analogous to those faced by surgeons globally and can be addressed by similar training paradigms.

Billings Clinic and the surgeons who practice there provide outstanding care to people across Montana and Wyoming and have expertise to share about rural health service delivery and how to build systems that can address the diversity and complexity of surgical problems in the face of both cultural and geographic distances. Together, we will train residents capable of rising to the challenges of rural surgical practice and develop innovative strategies to improve rural health more broadly.

The objectives of the program are to:

1. Provide UW general surgery residents with education in rural surgery, health equity and advocacy, including a one-year, non-ACGME-accredited clinical training experience and potentially a second year of mentored research and/or professional development opportunities;
2. Establish an ACGME-accredited rotation for senior UW residents;
3. Support Billings Clinic’s commitment to educating top surgical trainees from UW with rotations in general surgery and other pertinent specialties (e.g., therapeutic endoscopy, orthopedics, urology, obstetrics and gynecology, neurosurgery) at Billings Clinic, and rotations at critical access hospitals across Montana and Wyoming;
4. Support Billings Clinic’s regional clinical and education outreach initiatives; and
5. Establish a model academic-community rural surgical education program that enriches resident training, serves as a conduit for future rural surgeons, improves the health of people living in WWAMI communities, and enlivens the field of rural surgery more broadly.

The program will initially be available to residents during one of their research years or as a non-accredited fellowship after general surgery training (i.e., for board eligible UW general surgery graduates). Our goal is to mature the Billings-UW Rural Surgery Track into an ACGME-accredited rotation, elective, and/or year depending on the mutual needs of Billings Clinic and our residents. The program will start at the beginning of the 2023-2024 academic year. If you are interested in the Billings-UW Rural Surgery Track, please contact Dr. Barclay Stewart (barclays@uw.edu) or Dr. Dana Lynge (dlynge@uw.edu).