Using the Blue Cross/Blue Shield and Medicare records for 1 year in Utah, we examined the pattern of surgical performance for 15 selected procedures. Only 60% of those identifying themselves as general surgeons had their specialty boards. General practitioners performed 24% of the procedures. Urban general practitioners performed proportionately more surgery than did their rural counterparts. There was no clear pattern of difference in fees or length of stay by specialty or board certification status. For most procedures studied, at least a third of the rural patients had their operations in urban hospitals. In only 3% of the cases did an urban physician operate in a rural hospital. The pattern of surgery for rural and urban residents was strikingly similar.