Professional isolation in small rural surgical programs: the need for a virtual department of operative care.

S Canada depends on rural surgical services to support local emergency services, maternity services and access to basic surgical care. Despite this, rural surgical services are under siege. Communities are faced with an aging workforce in the roles of general practitioner with enhanced surgical and anesthetic skills, and rural operating room nurse. There are limited opportunities for training and continuing medical education (CME) and a lack of adequate infrastructure for operating rooms. Additionally, in the past 10 years a wave of service closures in small hospitals has been triggered in part by regionalization and the concomitant centralization of services in referral centres. This centralization has raised questions about the costs of maintaining services in small communities and the safety of such services. Although the evidence that informs planning is scant, the existing research is supportive of the quality of care provided in small surgical programs in rural areas. Despite this, the search for administrative efficiencies can lead to ad hoc decision-making and closure of services in vulnerable small communities, leaving rural residents to travel greater distances to access basic care and, in some instances, leading to less than optimal outcomes. When this happens, there is little capacity to foresee the cascade of unintended consequences for patients, their families and entire communities in which their health and welfare are in extricably embedded. THE SYMPOSIUM