Impact of the COVID-19 pandemic on rural general surgery staffing and endoscopic provision in Washington state: A qualitative study.

INTRODUCTION

General surgeons are pivotal in providing essential care to rural communities, especially in colorectal cancer (CRC) prevention via endoscopy. The COVID-19 pandemic worsened access to care in these areas. This study aims to identify post-pandemic changes in rural surgical care and identifies strategies to improve workforce and retention.

METHODS

We conducted semi-structured interviews with rural general surgeons from critical access hospitals (CAH) in Washington state. Interview questions were adapted from literature on medical workforce shortages. A coded theme analysis of the transcripts examined pandemic impacts on surgical workforce shortages, access to surgery, and strategies to address these gaps.

RESULTS

We contacted 43 rural general surgeons, achieving a 33 ​% response rate. We conducted 13 virtual semi-structured interviews. Thematic analysis revealed four main themes: (1) Pandemic Impact: Reduced elective procedures during the pandemic, followed by post-pandemic surge; (2) Colonoscopy and Endoscopy: Significant drop in elective endoscopies mid-pandemic, increased volume post-pandemic, and several delayed CRC diagnoses; (3) Staffing Issues: Shortages of anesthesia, nursing, and other ancillary staff, impacting surgery schedules and patient transfers; (4) Rural Recruitment/Retention: Surgeons valued practice autonomy, making differences in their communities, and personal rural upbringings. Suggested solutions include increasing rural practice exposure during training and offering better financial incentives.

CONCLUSION

The surgical workforce shortage in rural Washington has intensified post-pandemic. Key issues include elective procedure reductions, delayed CRC diagnoses, and staffing shortages. Enhancing recruitment and retention through early rural practice exposure and financial incentives can address these challenges, improving access to surgical care in underserved areas.