General Surgical Residency - Rural Track

Rural Surgery Track – Preparing Surgeons for Rural Practice

The Phoenix Integrated Surgical Residency offers an established Rural Surgery Track for residents committed to developing the breadth, independence and adaptability required for rural general surgery practice. Applicants interested in this pathway apply to and separately rank the dedicated rural categorical position through the Match.

The defining experience of the track is an immersive PGY-4 year at Billings Clinic in Billings, Montana. The year is intentionally designed around the realities of caring for patients across large geographic areas, limited local resources and complex systems of referral and transport. Residents learn not only how to perform surgery in a rural environment, but also how to determine what can safely be managed locally, when a patient requires transfer and how to coordinate care across a regional health system.

A Year Built Around the Needs of Rural Surgeons

During the PGY-4 year in Montana, the rural-track resident develops broad clinical and operative experience across the disciplines most relevant to independent rural surgical practice:

• General surgery and trauma at Billings Clinic, including experience caring for patients referred and transported from rural communities throughout the region.
• Relevant surgical and procedural subspecialties, including obstetrics and gynecology, urology, neurosurgery and orthopedics.
• Thoracic and vascular surgery, expanding the resident’s exposure to procedures and clinical problems that may be encountered in communities with limited specialty access.
• Twice-monthly experiences with Billings Clinic faculty at Critical Access Hospitals throughout Montana, providing direct exposure to the resources, decision-making and relationships that define rural surgical care.
• A six-week elective embedded with a rural surgeon in a rural community, providing an immersive view of the scope, autonomy, continuity and professional role of a community-based rural general surgeon.

Learning the Rural System of Care

Rural surgery requires more than a broad operative skill set. Residents must understand how geography, transportation, access to specialists, hospital resources and community needs influence every stage of patient care. Through the Billings experience, residents see this system from multiple perspectives: at a regional referral center, alongside specialists, in Critical Access Hospitals and in a rural community practice.

This combination allows residents to understand the full continuum of rural surgical care — from initial evaluation and stabilization in a small community, through transfer when needed, to definitive treatment and return of the patient to their home community.

Designed for Independent Rural Practice

The Rural Surgery Track is designed for residents who envision a career in rural or regional general surgery and want training intentionally aligned with that goal. The PGY-4 year provides an uncommon combination of broad operative exposure, specialty experience, trauma and referral-system education, Critical Access Hospital experience and longitudinal mentorship from surgeons who practice in Montana.

The result is a focused year of training intended to prepare graduates for the clinical breadth, judgment, resourcefulness and independence required to care for rural communities.

Rotation Leadership

Gordon M. Riha, MD, FACS General Surgery Residency Site Director, Billings Clinic

Dr. Riha is a general surgeon, trauma surgeon and surgical critical care physician at Billings Clinic. He serves as the General Surgery Residency Site Director and provides leadership for the Montana rural surgery experience.

Rural Surgery Track at a Glance