The U.S. Census Bureau has four categories to classify census tracts using measures of population density, urbanization and daily commuting: urban (>50,000 population), large rural (10,000-49,999 population), small rural (2,500-9,999 population) and isolated ( The Organisation for Economic Co-operation and Development further subdivides urban areas into small urban (50,000-200,00 population), medium-size urban (200,000-500,000 population), metropolitan (500,000-1.5 million population) and large metropolitan (> 1.5 million population). Most fellowship-trained pediatric surgeons practice in medium-size urban to large metropolitan areas. There is growing concern about the availability of basic surgical care for children in the extensive ex-urban areas of the U.S. 3 Alaish S.M. Powell D.M. Waldhausen J.H.T. Dunn S.P. The Right Child/Right Surgeon initiative: A position statement on pediatric surgical training, sub-specialization, and continuous certification from the American Pediatric Surgical Association. McEvoy reported that more than 10 million children live more than 60 miles from care by fellowship trained pediatric surgeons 4 McEvoy C.S. Ross-Li D. Held J.M. et al. Geographic distance to pediatric surgical care within the continental United States. but Alaish and colleagues concluded that, “Increasing the number of classic fellowship programs has been unsuccessful in distributing fully trained pediatric surgeons to underserved areas of the US and is not a worthwhile strategy to pursue.” 3 Alaish S.M. Powell D.M. Waldhausen J.H.T. Dunn S.P. The Right Child/Right Surgeon initiative: A position statement on pediatric surgical training, sub-specialization, and continuous certification from the American Pediatric Surgical Association. Valentine reported that 13% of individuals practicing general surgery do so in large rural, small rural or isolated areas. In 2011 he reported that, while recertifying general surgeons performed only 2 ± 14 PS cases (mean ± standard deviation) cases, they performed some 20% of the PS cases reported by the entire cohort of recertifying surgeons (those certified only in surgery as well as those with additional American Board of Medical Specialties certificates, including those certified in PS). 5 Valentine R.J. Jones A. Biester T.W. et al. General surgery workloads and practice patterns in the united states, 2007 to 2009: A 10-year update from the American Board of Surgery. Thus, practicing general surgeons substantially contribute to the surgical care of children. They can continue to provide surgical care for children if they receive adequate experience during residency in the evaluation, diagnosis, resuscitation, operative and postoperative management of pediatric patients.