Rural Surgeons' Conformity to the Specialty Code

177 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1981.This research describes the manner in which surgeons in nonmetropolitan practice deviate from the specialty code, and seeks to understand this deviation in light of ecological theory. The hypothesis is that the low density of specialists and associated lack of structural constraints on competitors, suppliers, financers, and consumers of surgical services leads surgeons in nonmetropolitan practice, more than their metropolitan counterparts, to deviate from the specialty code.The method used is a comparison of findings from a series of case studies of nonmetropolitan surgeons to defined standards and to existing data describing metropolitan surgical practice. To gather data on nonmetropolitan surgical practice, a random sample of 50 percent of the surgeons and family physicians in a 16-county nonmetropolitan area was drawn, and the practices of 12 surgeons and 18 family physicians were studied.Assessing how nonmetropolitan surgeons' performance related to the standards and compared to metropolitan surgeons' practice required (1) defining the elements in the specialty code by surveying journals, textbooks, and position statements of officials of the organized surgical associations and training programs; (2) identifying the practice patterns of metropolitan surgeons by surveying the existing research literature; (3) determining the amount of competition and support provided to surgeons by family physicians in metropolitan and nonmetropolitan settings; and (4) identifying differences in the structured practice setting for metropolitan and nonmetropolitan surgeons.The surgeons are faced with a practice setting in which hospital by-laws and procedures, malpractice insurance rates and claims, and health insurance plans provide no obstacle to family physicians who wish to perform surgery. The nonmetropolitan family physicians not only fail to act as suppliers, referring few patients, but also beome competitors in surgical performance. The surgeons adapt to the practice environment in a fashion suggested by Hawley (1950) in his work on competition. They adapt by becoming essentially family physicians themselves; by becoming subspecialists performing a large percentage of operative procedures considered the province of urologists, orthopedists,and plastic, thoracic or neurosurgeons; by doubling up on the performance of procedures not normally requiring a surgeon as assistant; or by expanding the number of communities they serve in an itinerant fashion.This documentation of nonmetropolitan specialist behavior deals with an under-researched area in the health services and profession of medicine literature. Results suggest that national efforts to place more physicians in rural practice should not ignore the importance of the lack of a structurally-supported medical division of labor in contributing to current problems in health care delivery in rural areas.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD