Episode 71

Are You Really Ready to Be the Only Surgeon in the Room?

Episode Transcript

Dr. Randy Lehman (00:32):

Hello, listener. Welcome back to the show. This is the Rural American Surgeon. I'm your host, Dr. Randy Lehman, and I have today with me the program director from University of Wisconsin, Dr. Anne O'Rourke. Thank you so much, Dr. O'Rourke, for joining us. It's my pleasure. Yeah, and we're doing our mini-series about training a rural surgeon. We've interviewed several programs throughout the United States that are focused in some way on training a rural surgeon. That has varied from a dedicated year, a whole dedicated program, down to a dedicated month. And we're going to talk today about what UW is doing. And actually, I'm very excited about this because I do have a very small piece of my practice that's in Wisconsin.

Dr. Randy Lehman (01:12):

I actually practice. at Tomah, like a very limited basis. And I went to the Wisconsin Surgical Collaborative. Great meeting. They had like flyers all over the North American Rural Surgical Society, like asking anybody in the country, why don't you come hang out with us? It's a great meeting. Yeah, great meeting. And so many people told me, hey, you got to talk to Dr. O'Rourke. So I've been looking forward to this for a long time. And the other thing is that I actually applied to your program back in 2015, it would have been.

Dr. Randy Lehman (01:41):

And I think it was a fledgling program, and I ranked it very highly, but then ended up matching down the road at Mayo in their rural track, which has had a lot of similarities. So why don't we start with just an overview of why does this program exist in the first place in your eyes?

Dr. Anne O'Rourke (01:56):

Thanks. I will just start by saying that I am originally from Tennessee and from a small farming community in Tennessee, but have really been... a Wisconsin lifer. I went to med school here, did my residency here and have stayed on. And so consider myself a Wisconsin person now. And when I did my training here, the expectation was that maybe two, one or two residents would spend some time doing academic development time and maybe go onto fellowship, but we were training surgeons to serve the community. Over time morphed, we became a far more academic healthcare center and doing great things like amazing research, cutting edge care.

Dr. Anne O'Rourke (02:35):

But that also kind of changed a little bit of how our training program was such that all of the residents were spending time doing dedicated research time in their training, extending their training to seven years, going on to fellowships and then going on to work. academic health care centers. And the University of Wisconsin has something called the Wisconsin Idea, which is that the boundaries of the university are really the boundaries of the state and that the university is there to serve the people of Wisconsin. And we really felt like we weren't fulfilling that part of our mission and said, we really need to figure out a way that we're actually training surgeons to help serve the people. of Wisconsin.

Dr. Anne O'Rourke (03:09):

And so, one of my predecessors, Dr. Chip Foley, partnered with some people in the state, got some grant funding, and we set up our rural surgery track with the idea that residents would train in five years rather than spending time and research time, be absolutely prepared and ready to take an independent practice, ideally serving a rural community in Wisconsin or a rural community elsewhere, recognizing that Wisconsin's not the only place that has needs with their rural population. And so that was sort of the genesis of the idea. And it has been. It's really a project of love for me. I really believe in it. And just a couple of years ago, actually, we're able to successfully get a compliment increase.

Dr. Anne O'Rourke (03:49):

And so while we used to have only one. resident in that track we now have two residents a year in that track awesome and that's compared to how many total so our total residency uh we have we graduate eight well with that complement increase we've gone up to eight so we were seven and now we're eight so six in our academic track and two in our rural track so how many have you graduated so far We have, gosh, I could probably name them all from starting from your class. So that would have been.

Dr. Randy Lehman (04:17):

If you've graduated one a year since 20, then it would be like around five or six, right?

Dr. Anne O'Rourke (04:22):

And I can tell you where they all are now, but.

Dr. Randy Lehman (04:25):

Have they successfully landed in rural surgery practices? They sure have.

Dr. Anne O'Rourke (04:28):

All but one. Most of them are. So we've got. One, our very first graduate, actually, Tomah is where his first practice was. And now he's someplace else in Wisconsin. And then our next graduate is in a small town in coastal Maine. Our third graduate is in Neenah, Wisconsin, which is actually one of our rural sites. Our fourth graduate went to, he is the. person who is not on a rural site. However, he's a really unique guy who speaks English, Vietnamese, and Spanish. And he is now serving a community in California that serves those populations. So he's serving an underserved population in a different way. It's certainly not rural. Our graduate from last year is in his hometown in Washington State in Chehalis, Washington.

Dr. Randy Lehman (05:15):

Awesome. And so have you... Is it going to be for 2020, like the new matriculating class that just came? You have two now?

Dr. Anne O'Rourke (05:23):

Correct. So I have two PGY-3s because this, for your listeners, I mean, we're at the very beginning of the academic year. Our new residence just started a month ago. So I have two PGY-3s, two PGY-2s, and two interns.

Dr. Randy Lehman (05:36):

Okay, perfect. And what I recall was up by Oshkosh somewhere, you had a site.

Dr. Anne O'Rourke (05:43):

We have a site in Neenah, Wisconsin, which is sort of the northeast part. It's probably most people would be familiar with Green Bay, maybe is kind of the closer thing. That's so kind of the northeast corner. And that's a medium sized practice, a busy, very busy group of surgeons. And then we were in Waupon, Wisconsin, which is not actually that far from Madison, critical access hospital. And our surgeon who was helping run that site had one of her partners retired. And of course, this is a common problem in rural hospitals all over. And she really felt like when she was by herself, she wouldn't be able to have trainees with her.

Dr. Anne O'Rourke (06:18):

And so we transitioned to really amazing critical access hospital in Western Wisconsin, in Baldwin, Wisconsin, which is just on the western border of the state.

Dr. Randy Lehman (06:27):

So was Appleton never part of it?

Dr. Anne O'Rourke (06:30):

Appleton is no, but you know, Appleton, they're close.

Dr. Randy Lehman (06:34):

Yeah. See, I'm a pilot. So that's where the Oshkosh thing has to come in.

Dr. Anne O'Rourke (06:38):

The air show is this weekend. So yeah,

Dr. Randy Lehman (06:40):

exactly. It's a lot going on. So very exciting. Okay. So how do the residents do it? So when do they go to these sites and what is different for the rural track person that compared to your other?

Dr. Anne O'Rourke (06:52):

um obviously not doing mandatory research would be one component and then what about their rotations so the uh their pgy one year they stay the whole time with us in madison so they don't go to their rural sites at all you're learning enough as you will recall as a new intern without the additional burden of traveling and feeling like you have to impress those mentors But their PGY2, 3, and 4 year, they have dedicated rotations at both sites. And so they return to those sites year after year and have this really nice longitudinal relationship with the surgeons at their two sites. And then their PGY5 year, they're doing their chief rotations here in Madison. So they travel as 2s, 3s, and 4s.

Dr. Anne O'Rourke (07:37):

Depending on the size of the class is how long their rotations are. But generally, they're six or seven weeks. So they travel for both of them. And they have housing. We have housing for them there.

Dr. Randy Lehman (07:46):

Okay, great. So housing is included. What about you have any residents that have families and how do they make that work?

Dr. Anne O'Rourke (07:53):

So it's a great question, and I think we've lost a couple of really great candidates because they had concerns about being away from their families for those rotations. you know, three years in a row. The house that they have in Neenah is owned by the healthcare organization and it is, they might have it by themselves, but usually there might be other learners that they're sharing the house with. So it might be an OT student or a CRNA. And so they're not traveling with their families. When they were in Waupon, they were staying in an extended stay hotel. And when we first moved to Baldwin, that's where we were keeping the residents.

Dr. Anne O'Rourke (08:35):

But now that Western Wisconsin Health, the hospital there, has engaged a house and they're there by themselves. So if they wanted to, their families could come with them. And each resident has kind of worked it out. The, you know, the drive time is two or three hours. And so a lot of, and they don't really have a ton of burden of weekend call. So sometimes the residents will come back and forth for the weekends to see their families.

Dr. Randy Lehman (08:59):

Okay. And like, just give me an idea. So it's two, three, and four, like what percentage of their rotations do you, would be a range from like low end to high end that they might do at these other sites?

Dr. Anne O'Rourke (09:11):

So it's just basically we're subbing out a rotation that they would have done in Madison for a rotation at their rural site. It ends up being about almost a year of their five years is spent at their rural sites, just spread out over their two, three, and four year.

Dr. Randy Lehman (09:26):

Yep. Yeah, that makes sense. All right. And what kind of an applicant are you looking for?

Dr. Anne O'Rourke (09:33):

That is, you know, I have very different, I look for very different things for our rural applicants than I'm looking for for our academic applicants. And one thing I will say for medical students that are listening, our tracks have two different NRMP numbers. So when you're applying through the match, you can apply just to the rural track, just to the academic track, or you could apply to both And for me, actually, if someone applies to both of our tracks, that tells me that person, while very interested in coming to Wisconsin, maybe is not someone who really has a very specific rural interest or a very specific academic interest. And it is a little bit. of a turnoff, to be honest.

Dr. Anne O'Rourke (10:14):

So for our rural track, I'm looking for, were they in, a lot of our medical schools now have dedicated rural tracks in their med school. So that's a huge bonus for me. Or if they have been involved in any kind of rural programming or extra study while they were medical students, if they have a rural background themselves, that is a big. bonus for me, or if they flag that they're interested in being at a rural site. Although I don't, I definitely don't look at that as far as the signaling, if they say rural site or urban site, because, you know, you need the volume for your training to be a surgeon to go practice.

Dr. Anne O'Rourke (10:53):

So I don't really pay that much attention to it, but. Really rural backgrounds, dedication to serving rural populations, and if you have some emphasis of rural medicine in your medical school training.

Dr. Randy Lehman (11:05):

That's perfect. So thinking back to some of the most successful residents in recent years that have kind of come through and really shined, what are some of the traits that they had that made it that way?

Dr. Anne O'Rourke (11:18):

And I truly believe that this is what you need to practice in these environments. You really have to have courage and be somebody who can apply the principles that you know to a new situation and to be always someone that's always learning. Because I am fortunate to work in an environment where I have dozens of partners who can come. to my operating room who can help. I have, you know, basically unlimited resources. And instead you're working in an environment where you might be the only surgeon and you, that gets really lonely as you know, in the operating room, when you're faced with something that you've never seen before, you're not sure what to do. You don't have unlimited amount of units of blood.

Dr. Anne O'Rourke (12:02):

You might not have platelets, any of that kind of stuff. And so. I think people who are, have confidence and courage and are willing to learn new things all the time or have the resiliency it takes to practice in that kind of environment.

Dr. Randy Lehman (12:15):

Yep. Courage and resiliency. That's great. How about subspecialty training? So, you know, the crazy part about rural surgery is that rural surgery is not rural surgery, not rural surgery. It's such a huge variation and rural surgery out West is a lot different than rural surgery in the Midwest or the East. So I'm in Indiana. I'm in the building where I came for my eight-day well child visit. As we're speaking here, I just got done with clinic across the street at the hospital I was born in. But we've got cities of 200,000, two of them, 45 minutes in each direction. And this is a critical access hospital. I think it's important, but it's almost more of a convenience factor.

Dr. Randy Lehman (12:54):

and a economic development factor for my town point of pride for my community like i want the hospital to be open but but it's not as maybe life or death as like out west i was talking to another buddy of mine and he's a town of 5 000 people that's 120 miles away from the nearest big city only 100,000 people. And so there's this huge spectrum when you get out and what you might be doing. And you might find yourself in a place that does or does not have an ICU, does or does not have any other subspecialties. Maybe they have ortho, urology, OBGYN, maybe they don't.

Dr. Randy Lehman (13:28):

So what I'd like to ask is, do they get any subspecial, like for me in my practice now, I do, I mean, I basically do a lot of outpatient elective surgery, but I, but I don't do Whipple's and esophagectomy and liver resection, but yet I do carpal tunnels and GYN and hysterectomies and tubal ligations and vasectomies and circumcision, did a circumcision yesterday. stuff like that, that maybe you wouldn't do if you were in the city. So do they get exposed to some of those subspecialties? And if so, is it in Madison or in their other rotations? And how do you set that up?

Dr. Anne O'Rourke (13:59):

That's a great question. It's for sure. We feel very strongly about their training in OB, particularly in C-sections. And so we have a couple of ways that we're getting some additional OB training. Our OB residents in Madison have their academic, their lecture time on Thursdays. And so the labor and deliver floor doesn't have any OB residents on it on Thursdays. And so. When our rural residents are on certain rotations, they just leave the service that they're on to get experience with OB, with elective C-sections, or if something emergent is happening with that. and anything else going on with Gine. And then at particularly the Baldwin, our rural critical access hospital, they're getting a lot of exposure to OB.

Dr. Anne O'Rourke (14:41):

And in fact, UW-Madison actually has a rural track in the OB-Gine residency as well. And that's a site for our OB-Gine residents to go to also. The person who's a PGY-4 in our rural track this year actually as a PGY-3, did a dedicated hand rotation. And so he's, because of where he's going to be in practice, that's going to be part of his practice as well. And so there's a little bit of elective, they don't really have any ortho exposure other than what they get on their extensive amount of time on the trauma service, but the gyne, and they get a little bit of urology exposure at their rural sites as well.

Dr. Randy Lehman (15:17):

Do many of your residents sign their contracts early and they kind of know where they're going and then design their training around it?

Dr. Anne O'Rourke (15:23):

Not everybody. It's been a little different for everybody, but yeah. Thomas, our current PGY-4 already has a job in his, close to his hometown in rural Minnesota. So that he'll be starting with. And actually one of our, we have two graduates that are in NENA. Nicole, a very interesting fellow, she did a rural endocrine surgery fellowship, which involved doing a lot of outreach endocrine. And so her practice is now in northern Wisconsin, where she does do elective endocrine surgery, but still does general surgery outreach. beyond the community of Nina and is still taking general surgery call. And she knew about, she knew she was going to be doing that before she even did her fellowship.

Dr. Anne O'Rourke (16:02):

Like that was part of the plan for her. Yeah.

Dr. Randy Lehman (16:04):

If there was anything out, I'm going to answer it and you tell me if you agree. Okay. If there's something outside of general surgery that you think is most important for a rural trainee to be skilled at, I think it would be number one endoscopy. number two, C-sections, and then everything else. Do you agree with that? I do agree with that. Is there anything else that would make the list as a close third?

Dr. Anne O'Rourke (16:28):

You know, I think actually trauma, like you need to be comfortable with a resuscitation, right? And you get plenty of that. Any general surgery residency is going to give you that. But again, you're not at a level one center and you might be at a level four center, which means those things are actually more infrequent. And when someone sick comes in, you don't have the kind of resources you need to be able to stabilize them and be the calm in the storm to help stabilize that person enough to get them where they need to be. More so if you're someplace like you mentioned, where you're 150 miles away from even a level two or a level three center.

Dr. Anne O'Rourke (17:06):

And of course, in the Midwest, as you know, it may not be geography that's limiting you, but it sure as heck can be the weather. So it may be that you're not your patient's not going anywhere because there is a blizzard happening.

Dr. Randy Lehman (17:19):

I agree with that. OK, how about when you're when you're. Residents graduate, like how many cases are they graduating with? Are they graduating just like with the skill set to be comfortable? I mean, do you recommend them against going into a solo practice? Do you recommend they have partners? Do they need the partners?

Dr. Anne O'Rourke (17:37):

I think they're ready. And our residents in the rural tract graduate on average with 250 to 300 more cases than the residents from our academic tract. And they're getting that at their rural sites. And also with significantly higher endoscopy numbers, as you pointed out, like that's a big part of everyone's practice. I think everybody's a little different and we really sit down and talk about what they want. And I think a lot of whether or whether you're solo or not has to do with your confidence.

Dr. Anne O'Rourke (18:05):

And so I actually think your senior partners, your first couple of years in practice are some of the most important decisions you can possibly make because that's, as you know, those first couple of years you're in practice is when everything changes. Like I can definitely remember. even for me, every time the door opened to my OR, I'd look over my shoulder to be like, is someone coming to help me? And then you remember it's you, you are the one in charge. And so some people I think are ready and like, I got this, but some people just want to know that there's somebody with a little more gray hair that's around for questions or just to kind of.

Dr. Anne O'Rourke (18:41):

So that you feel confident in yourself. And I can definitely, one of my trainees, like her plan all along was to go with really good senior partners, get her confidence and then move someplace smaller. But I think that's a really personal decision and one you can start making once you know yourself, probably when you're around your PGY4 year. That's the how comfortable you feel.

Dr. Randy Lehman (19:02):

Yeah, that's beautiful. Well, I think this is a pretty good summary. I have a good idea of your track. Is there anything that we're missing that you would really want the audience to know about your track?

Dr. Anne O'Rourke (19:10):

It's a great... Again, I'm just really proud of it, and I'm really proud of all of our trainees. I guess the other thing I would say is because we have these examples of people going out being really happy and successful in practice, some of our academic track residents now have chosen to go into rural practice instead, even after doing ADT. I think it's actually becoming something that a lot of people just don't even think about. If you've been if you spent all your time in medical school in an academic health care center and all of your rotations were with academic surgeons and then in your residency, you're only around academic surgeons.

Dr. Anne O'Rourke (19:47):

I don't think and this is what I think is actually the crux of our whole rural track. If you never see someone practicing general surgery, so someone like you, Randy, who's like in a day, you do endoscopy, you do a hand and you take out somebody's gallbladder. If everyone that trains you only does liver surgery or only does colon surgery. It never occurs to you that you could be somebody who's confident and competent and can take good care of patients as a generalist. You have to have examples of those people. So that is what, you know, however that rural track gives you those examples so that you realize that people can be really great surgeons.

Dr. Anne O'Rourke (20:26):

the pillars of their community, and the financial backbone of their hospital in their town, then you don't even, you can't even imagine that you could practice an environment like that. I think all our rural tracks, that's ultimately what they provide for the trainees.

Dr. Randy Lehman (20:39):

What do you think is the primary appeal to rural practice?

Dr. Anne O'Rourke (20:42):

I think it's different for different people. Some people, that's where they want to live and where they want to raise their families. And because that's recognize the value of living in a small town. Um, for other people, it's because they do want to be general surgeons and that's, you couldn't pay me. I mean, you could probably, you could pay me a million dollars to help somebody. I'd have to help somebody do a Whipple. Like even when I was a resident, that was not my cup of tea, but. I like still be, I mean, I'm not in a rural environment, but I'm still a general surgeon as a trauma surgeon and an acute care surgeon. I take care of everything.

Dr. Anne O'Rourke (21:17):

I would miss it if I was just sub specialized that much. I still take pride in being uncomfortable, not always knowing what to do, having to still look things up because even though my hair's getting gray. Sometimes I see stuff I've never seen before.

Dr. Randy Lehman (21:33):

Yeah. Think about myself. I remember being a medical student and I took some tests like learn yourself what specialty you want to do kind of thing. I thought I was going to do ER when I went to med school.

Dr. Randy Lehman (21:45):

didn't really understand fell in love very quickly with surgery was like obviously i was going to do surgery nothing else but i also wanted to go back to my hometown so i don't a lot of things just happened and fell in place and and i'm like in this you know the japanese concept of icky guy heard of that like i'm like in the middle you know what the world needs what you're good at what you enjoy what you can get paid to do hitting all so for me it's just kind of you know providential i But at the same time, if you're going to tell something, what I'd like to do is inspire other people to go out and do general surgery for

Dr. Randy Lehman (22:15):

the right reasons. So meaning know what you're getting into, because I've heard it said that there's two people in rural surgery. There's the people that want to be there and the people that have to be there.

Dr. Anne O'Rourke (22:23):

That's fair. Yeah.

Dr. Randy Lehman (22:25):

Sometimes people are not good and they get chased out of the city and they can't really hold their own. And sometimes they're lazy. And there's a lot of and I've come across a lot of them, you know, doing twelve hundred RBUs a year or whatever and just like kicking back. And it's it's kind of embarrassing, I think, on the whole field, if you will. And I'm not doing that. But to me, it's also you don't have to be a board certified workaholic. You know, you can figure out your level that works for your family. It can change over time. But when I was taking those tests, it said.

Dr. Randy Lehman (22:55):

hey you love procedural care you love episodic care you don't love um owning a patient for their entire life so rheumatology was the very last thing because you like fixing problems rheumatology they never fix problems they never get rid of a patient they just manage for their whole life but then also that said you like to do quick short cases and like higher volume of it rather than like you know some people really love doing cracking a chest and doing a big you know, six hour, you know, bypass or doing their whipples and doing their, their hepatectomies, esophagectomies and things like that.

Dr. Randy Lehman (23:26):

And I mean, honestly, like my neck can't tolerate it is one thing, but I also just can't focus for that long. So for me personally. things that ranked highly were like urology, ortho, ENT, OBGYN, general surgery is kind of like up there, but sort of just in the middle. And then I realized, oh, geez, rural surgery can be like all the chip shots from all those specialties. You know, why do people like to do peds and surgeon? Because what you just said, trauma too, you operate over the entire body and you get variety.

Dr. Randy Lehman (23:58):

Other variety is how many types of people do you get to operate on people from age zero to 99 men and women both and so then you pigeonhole yourself in a urology practice or ob-gyn practice and you really get selected whereas yeah i can do abscess drainage on a neonate one day and circ literally circ on a neonate yesterday who just over a month old and then the next day like i just saw an 89 year old lady for you know her dysphagia so It's this spectrum that those are the real good reasons why people should go into general surgery and want to work, want to do a really good job and provide care.

Dr. Randy Lehman (24:33):

And then when you do that, all the other things come.

Dr. Anne O'Rourke (24:36):

Like you serve your community. I mean, there's such good research that our patients are actually willing to accept. rates of complications to be close to home. And I don't mean to suggest that it's a guarantee that you'll have a higher rate of a complication because that's not true at all, right? You can have really successful programs in small hospitals, but people don't want to travel. I mean, I can definitely think of my own family members, the idea, even though by driving time now where I grew has kind of been absorbed by the greater Nashville area, but it certainly wasn't like that when I was a kid.

Dr. Anne O'Rourke (25:08):

But the idea of having to drive from our town an hour to get to Nashville to go to Vanderbilt for some specialty care, nobody wanted to have anything. They were like, how am I going to drive in Nashville? Where would I park? Like that kind of stuff just. It really stresses people out and it's a huge financial burden for our patients that do have to be here for their families to travel and see them and to get them back and forth to appointments. And you shouldn't have to travel two hours to get your appendix out. Nobody could, right?

Dr. Randy Lehman (25:35):

Preaching to the choir. I agree. And that's where I used to tell people that they, you know, basically it's the same equipment. You're not getting any better of an operation, like for the things that I do. So I can sit there and look at them with straight face and I can say, you know, I used to be Mayo Clinic, you know, I'm doing a residency there. And, uh, somebody flies in on their private jet from Abu Dhabi and lands at the, at Rochester international airport and comes and sees me. And then I, and they get the second year resident fixing their umbilical hernia, you know, and flying over thousands of capable surgeons on the way there.

Dr. Randy Lehman (26:07):

So what I'm bringing to their town is the same operation that you would, you know, you can't exceed. But then I actually had my PD on to this show a year ago or so, and she brought up a point and I actually kind of believe it. But I don't want to I don't want to say things that are I don't know, you don't want to be too much like tooting your own horn or like, you know, say something that's not really true. and just kind of dig in to hear your own echo chamber and whatnot. But she said that it's the same operation, but the care is actually better when they get care. with you because their family can be involved.

Dr. Randy Lehman (26:39):

Their follow-up is easier. Complication management is easier. And I actually kind of have bought that and I've kind of paid attention. And I'm starting to believe that's actually true, that it's actually better for that patient to have their operation in the town where I am. Not even equivalent, it's better.

Dr. Anne O'Rourke (26:57):

I mean, you've seen this patient who by all metrics should not do well because they have a terrible problem. And because they have a family that is so willing to help take care of them and so on the ball, they do amazing because they have this support system. And the opposite is true to somebody who has like a minor complication doesn't do well because they don't have any support. And so that is, I mean, that's exactly what your PD was saying. Like we serve a large Amish community. I'm sure you have a large Amish community that you serve as well. And I never worry about discharging those patients with things that I would never discharge anyone else about because I know the community.

Dr. Anne O'Rourke (27:36):

It's going to take care of those people in a way that no other community honestly would be able to do.

Dr. Randy Lehman (27:42):

That's a good point. I love it. Anything else that you'd like to add before we close it out?

Dr. Anne O'Rourke (27:46):

I'm sure I'll think of something after we get off. I wish I could say it in French, but I'm just not fancy enough. But there's this whole thing like the wit of the staircase, like when you want to have some retort and you don't you don't think of it until you walk away and are walking up the stairs. It'll be sort of the same thing. I'll be like, oh, well,

Dr. Randy Lehman (28:02):

you can shoot me a text and I'll throw it in the show notes and that'll be just fine. Um, but I really appreciate you taking the time and this has been a great intro into your program. I think you guys are doing great things up there in Wisconsin. So thank you.

Dr. Anne O'Rourke (28:14):

We appreciate it. And to all the Mets students who are listening, I look forward to seeing your application this fall.

Dr. Randy Lehman (28:20):

Absolutely. And thank you very much to the listener. We will see you on the next episode of the Rural American Surgeon. See you at the next episode of the show.

Timecode:

00:00 Cold Open: Stabilizing Rural Trauma Patients

00:32 Introducing Dr. Anne O'Rourke

01:56 Why UW's Rural Surgery Track Exists

03:49 Expanding the Rural Surgery Track

04:25 Where Rural Surgery Graduates Practice

05:36 UW's Rural Training Sites

06:40 How Rural Residents Rotate Through the Program

07:46 Housing, Families, and Travel During Rural Rotations

09:26 What UW Looks for in Rural Surgery Applicants

11:05 Traits of Successful Rural Surgeons

12:15 How Rural Surgery Varies by Geography

13:28 Subspecialty Training for Rural Surgeons

15:17 Planning Training Around a Future Rural Practice

16:04 The Most Important Skills Beyond General Surgery

16:28 Trauma Readiness When Resources Are Limited

17:19 Case Volume and Readiness for Independent Practice

18:05 Choosing Senior Partners After Residency

19:47 Why Exposure to Generalists Matters

20:39 The Appeal of Rural General Surgery

22:15 Who Should Choose Rural Surgery

23:58 The Variety of Rural General Surgery

24:36 Why Local Surgical Care Matters

26:07 When Rural Care Can Be Better for the Patient

27:42 Closing Thoughts and Advice for Applicants