SURGERY FOR RURAL SURGERY FOR RURAL AMERICAAMERICA

Thomas H. Cogbill, M.D.

Gundersen Lutheran Medical FoundationLa Crosse, Wisconsin

Gundersen Lutheran Health Gundersen Lutheran Health SystemSystem

Fully IntegratedFully Integrated

Physician-LedPhysician-Led

453 Physicians453 Physicians

6159 Employees6159 Employees

Main Clinic – La Crosse, WisconsinMain Clinic – La Crosse, Wisconsin

(population 51,000)(population 51,000)

12 General Surgeons12 General Surgeons

Branch Clinics – 25 LocationsBranch Clinics – 25 Locations

9 General surgeons9 General surgeons

GL SURGICAL RESIDENCYGL SURGICAL RESIDENCY

Began in 1974Began in 1974

Currently 2 Categorical Positions/YearCurrently 2 Categorical Positions/Year

Only Surgical ResidencyOnly Surgical Residency

Single Fellowship – Bariatric/MISSingle Fellowship – Bariatric/MIS

GL SURGICAL RESIDENCYGL SURGICAL RESIDENCY

Committed to General SurgeryCommitted to General Surgery

High Volume Open CasesHigh Volume Open Cases

High Volume Laparoscopic CasesHigh Volume Laparoscopic Cases

Critical Care – 2 Months (R1/R3)Critical Care – 2 Months (R1/R3)

R4/R5 Trauma Resuscitation LeadersR4/R5 Trauma Resuscitation Leaders

GL SURGICAL RESIDENCYGL SURGICAL RESIDENCY

Obstetrics/Gynecology – 2 Months (R3)Obstetrics/Gynecology – 2 Months (R3)

High Volume Endoscopy – 2 Months High Volume Endoscopy – 2 Months (R3/R4)(R3/R4)

Rural Surgery Elective – (R4)Rural Surgery Elective – (R4)

Practice-Based Learning CurriculumPractice-Based Learning Curriculum

Practice Management Practice Management CurriculumCurriculum

Ethics Grand Rounds (6/year)Ethics Grand Rounds (6/year)

Coding & ReimbursementCoding & Reimbursement

MalpracticeMalpractice

ContractsContracts

Practice ManagementPractice Management

Rural Surgery ElectiveRural Surgery Elective

Prairie du Chien, Wisconsin (pop 6047)Prairie du Chien, Wisconsin (pop 6047)

Decorah, Iowa (pop 7944)Decorah, Iowa (pop 7944)

Anticipated Practice SitesAnticipated Practice Sites

Emphasis on AcademicsEmphasis on Academics

Require 2 PublicationsRequire 2 Publications

Require 2 PresentationsRequire 2 Presentations

Evidence-Based LearningEvidence-Based Learning

GraduatesGraduates

FellowshipFellowship 24%24%

Urban/Large Rural Urban/Large Rural

General SurgeryGeneral Surgery 26%26%

Small Rural General SurgerySmall Rural General Surgery 50%50%

Postgraduate ResponsibilityPostgraduate Responsibility

1.1. Faculty clinical resourceFaculty clinical resource

2.2. CME programsCME programs

3.3. Teaching Teaching

a. ATLSATLS

b. Rural electiveRural elective

Essentials for Rural SurgeryEssentials for Rural Surgery

Strong 5-Year Core General SurgeryStrong 5-Year Core General Surgery

Obstetrics/GynecologyObstetrics/Gynecology

EndoscopyEndoscopy

Surgical SubspecialtiesSurgical Subspecialties

Practice Management CurriculumPractice Management Curriculum

Full Immersion Rural Surgery ElectiveFull Immersion Rural Surgery Elective