Background: Subspecialty surgeons in rural and regional settings must balance maintaining specialist expertise while providing broad general surgical care. This creates challenges in clinical breadth, professional isolation, and workforce sustainability, highlighting the need for improved support for trainees and early-career fellows. Reflections: My experience as a subspecialist surgeon working across regional and metropolitan NSW suggests rural practice offers high-value learning in autonomy, adaptability, and broad surgical capability. However, limited access to subspecialist mentorship, supervision, and formalised rural curricula is not always offset by opportunities to manage complex cases independently, exposure to diverse pathology, and leadership development. Consequently, even after rural rotations, subspecialist trainees and early-career fellows may lack confidence and readiness for independent rural practice. Transition gap: The transition from subspecialist training to rural generalist practice is a vulnerable phase. In the absence of ongoing mentorship, collegial support, and clear professional development pathways, early-career surgeons may experience isolation, excessive workload, and reduced preparedness for complex care. Flexible employment models, including fractional or shared metropolitan–regional appointments, may help bridge this gap and support workforce sustainability. Policy implications: Addressing rural surgical workforce inequities requires policy to extend beyond mandated rural exposure toward practice readiness and retention, including: a) Structured mentoring and peer support into early fellowship years b) Recognition of broad general surgical capability as a distinct skillset c) Funding flexible cross-site employment models d) Alignment of training pathways with rural workforce planning Conclusion: Rural surgical practice offers both challenges and significant educational value. Recognising its contribution and supporting flexible models of practice may strengthen training and help build a sustainable rural surgical workforce.