Perhaps the need for surgery in rural residents has to do with a strenuous life which results in more wear and tear on their bodies as compared to city dwellers.

blacksmith-271984

I could not agree with you more.

Perhaps it has to do with having access to preventative care as well.

Those needing surgery are likely not working out at the y after their days labor is finished, they go back out in the evening to finish their labor

"The authors say their findings could mean that rural residents are sicker, getting treatment they don't need, or more likely to delay treatment for aches and pains until they worsen and require surgery." It is the latter. They work at riskier, more physical labor and put off treatment until they get so bad, they need surgery. They don't get the surgery in the rural areas, they have to go to the metro areas for it.

Isn't it interesting the conclusions that people (who really know nothing practical about what they are studying) come to? Makes for interesting reading, though.

I'm in a rural area, and have noticed that long term follow up with specialists and subspecialists can be difficult. My patients are more likely to opt for a definitive procedure (surgery) than more conservative options that require multiple trips back and forth to the larger medical center, almost 2 hours away. Many would prefer to "just get it overwith", and some actually choose early surgery so that they can get back to work (few jobs here - nobody wants to lose theirs), or can't afford the gas to travel repeatedly to the specialist.

In our modern society with modern communications and transportion I cannot see that access to a surgeon is a huge issue except in extremely rural areas. My grandmother lived in a small town and drove or was driven to a regional medical center that was 120 miles away....not a big deal.

It seems to me that the methodology of this study was flawed for determining if rural areas lack healthcare providers. People who are seriously sick or in pain are more likely to tolerate travel over long distances to seek help (in the case of aortic aneuryisms, they happen so fast that they can kill long before a person gets to the hospital). This is not true for small "every day" problems, some of which can also be serious. Outcomes for people with heart disease, diabetes, chronic infections, cancer etc. are still worse for rural populations, and that's because they don't have enough primary care physicians.

And that's before factoring in that we already have a primary care physician shortage in this country.