Meet the only doctor in Scotland training to be a rural general surgeon

So while his peers are specialising in parts of the body, he has chosen placements that will give him broad experience. He is currently working with breast surgeons at the Royal Alexandra Hospital in Paisley, unusual for a specialist registrar unless they want to specialise in breast surgery. He is also planning a stint at the new Royal Hospital for Children in Glasgow.

His plan is to be able to offer a wide range of emergency surgical care and carry out some routine operations for people who live a hundred miles - or a boat ride away - from the nearest district general hospital.

Dr Fergusson said: "I'm interested in this career because I have always enjoyed dealing with a variety of conditions and patients and I think that remote and rural general surgery gives you the opportunity to have the widest, most interesting kind of practice that is possible in the UK."

He tasted life as a medic on the Shetland Islands shortly after medical school, but said many of his peers do not really know what remote and rural work is all about.

He said: "There is a mind set of sub specialism. We are not used to operating outwith our comfort zone. Everything is very tightly controlled and regulated now and that is in many ways a good thing, but if you are going to be a confident, good remote surgeon you need to be able to think outside the box and think outwith your comfort zone and that is not by and large what we are trained for."

Knowing when to refer patients to specialist centres, or seek outside expertise, is part of the rural general surgeon's expertise. But, there are times on islands when the weather can make transfers to the mainland impossible. Gordon McFarlane, Shetland surgeon, said high mist or wind could delay flights by 24 hours.

Without any surgeons to operate on the island, some patients would face difficult compromises. While patients with appendicitis or hip fractures can survive long waits to theatre - it is not recommended. As for mothers who run into problems in Labour, Mr McFarlane says: "The worst case scenario is you lose the baby."

Laura Polson, from Shetland, says the birth of her first son was difficult so a caesarean section was planned for her second - only for her waters to break early. She was admitted to the Gilbert Bain Hospital in Lerwick wondering, as it was a Saturday, what to expect. But when the labour pains began the staff moved swiftly. She said: "My husband and I were very impressed. They were very efficient. They said 'we will get you down to theatre.' It was very fast, but there was no panic on."

Her second son David is now one week old. Ms Polson, 33, said it was frightening to think what would have happened if a surgeon had not been available. She said: "The thought of being moved let alone on a flight during labour - it is not even just the practicalities of how comfortable it would be - it would be quite scary."

Shetland currently has three permanent surgeons, but the workforce across Scotland's rural general hospitals is fragile and Dr Fergusson is the only person currently being trained to replace those who leave or retire.

He said the questions hanging over the future of the rural general hospitals - with some believing they should just become cottage hospitals - also put young surgeons off careers there. He said: "We need clear commitment from the Scottish Government to continue a substantial general surgical service in these places."