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Missing from this debate about CAC's and generalism is the uniqueness of the CAC for Enhanced Surgical Skills(ESS) for comprehensive care by rural FP's. First, FP's with this CAC in surgery and/or operative delivery will only and always be rural physicians. There is not, nor will there ever be, an urban scope of practice for FP's performing major surgical procedures. Second, these FP's will always practice comprehensive care. The small volumes of rural surgical practice exclude absolutely any opportunity for a focused surgical practice. Together, these two realities position the CAC(ESS) as unique as a rural credential for comprehensive care by Family Physicians. The CAC which resembles ESS most closely is Family Practice Anesthesia which still offers opportunities for focused practice in either anesthesia alone or in combination with an ER practice in larger centers. The FP who acquires rigorous surgical training, like the General Surgeon who acquires operative delivery skills, is a true rural generalist.
Competing Interests: None declared.