Utah educators are taking this same can-do approach in tackling an even more serious problem - a shortage of general surgeons, especially in rural areas.

The University of Utah School of Medicine has designed a pilot general surgery rural rotation program in Ogden to keep more of the general surgeons we graduate each year living and practicing in rural Utah. Under the direction of Dr. Robert Moesinger, surgery residents are exposed to surgical problems that are handled by specialists in urban areas, but must be managed by general surgeons in rural areas.

General surgeons are the specialists who perform life-saving emergency procedures for victims of car crashes, farm accidents and other catastrophes. They are critical to the success of the rural health-care system - and their numbers have dwindled to dangerously low levels. According to the latest data available, Utah ranks 48th among the 50 states in the number of general surgeons per capita.

The main reasons for this shortage are threefold. First, there are too few medical students. In the 1980s and 1990s, the United States feared a future glut of physicians and put a cap on medical school enrollment. Today's rising health-care needs, growing population and longer life expectancies weren't anticipated, and the cap has resulted in a shortage across many medical practice areas.

Challenges of rural living: Small-town life has many positives, but some medical students and their families can find it isolating. In addition, rural practice can require frequent on-call duty.

Changing focus: Traditionally, rural surgeons would perform a variety of basic emergency procedures in the communities they served. Today's medical training has become more focused, however, and many young general surgeons don't perform the Caesarean sections and other procedures their predecessors did.

As a result, it is difficult to find general surgeons who can deal with the full spectrum of medical care needs in rural areas.

The Journal of the American College of Surgeons recently highlighted the "crippling effect" that the lack of general surgeons will have on the financial viability of rural hospitals. Citing data from the Journal of Rural Health, the article warned that two of every five hospital administrators surveyed said that their hospitals would be forced to close if surgical services were discontinued. Obviously, this is a grave concern for all of us.

In addition to what we're trying at the University of Utah, work is ongoing at the federal level to address this issue. The American College of Surgeons, of which I am a member, is working with Congress to expand medical school enrollments and residencies, develop programs to train general surgeons to work in rural communities, fix counterproductive reimbursement systems and limit medical malpractice liability claims.

These changes are vitally important to successfully turning this dangerous situation around.

As the hospital community in Utah is all too well aware, you can be a long way from emergency medical assistance in this part of the country. General surgeons play a key role in keeping us alive in the event of traumatic injury, and we need more of them if we want to maintain our excellent Utah quality of life.

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* JAMES MCGREEVY is a professor of surgery and program director of general surgery residency at the University of Utah School of Medicine. He lives in Holladay.