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There is limited information regarding physician satisfaction as it relates to the presence of a surgical pathology department in rural hospitals. Physician satisfaction directly influences the quality of patient care. The theoretical frameworks that informed this study included institutional theory and population ecology. The research questions addressed differences in levels of physician satisfaction between physicians who have access to an on-site surgical pathology department and physicians who do not have such access. The research also examined differences in satisfaction between physician specialties that have or do not have access to an on-site surgical pathology department services. A quantitative, cross-sectional study was employed utilizing three primary instruments: the Henry Ford Hospital Survey, Standardized (Synoptic) Pathology Reports, and PAR Medical Colleague Questionnaire. Statistical analyses including ANOVA, linear regression, and t tests were used to examine the relationships between the study's variables. The results revealed that there is statistically significant evidence to support that on-site surgical pathology department services influence physician satisfaction. Potential implications for positive social change from this study include a better understanding and awareness of the relationship between physician satisfaction and utilization of on-site pathology services, which may ultimately benefit healthcare facilities by more intently addressing quality of care and patient satisfaction.