Confused about Urban vs. Rural

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RuralFamilyMed

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Hello I'm currently an undergraduate interested in spending my career working with the underserved. I am also keen on applying to the National Health Services Crops Scholarship (though that's a long shot).

I was wondering what the benefits were working with urban vs. rural populations? I'm spending this summer in Front Royal, Virginia working withing a rural Community Health Center, but wanted some advice from experienced individuals!

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Your questions are very broad and too hard to answer. Urban vs rural really is an individual choice of practice. There are underserved of course in both factions and each have their own unique problems and lack of access to good quality health care.

Inner city poverty plays a huge role in poor health
Rural, poverty also play a huge role plus distance to any type of health care provider depending on geography and location.
 
not a doc but I work in both urban and rural locations. my experience has been that urban positions are busier and pay more and have more subspecialty back up available 24/7/365.
rural positions may not be as busy and scope of practice may be broader because certain specialists aren't around so you become the defacto go to guy/gal for a broader range of services. for example at one of my rural jobs ortho is only on call every other day so on "off days" I end up doing more reductions than I ever would do at my urban job where ortho is always available and almost always in house.
I prefer rural myself despite the lower pay. seeing 1-2 pts/hr is a lot nicer than seeing 4-6 pts/hr. and I utilize my full range of skills at my rural jobs but at my urban job I work at maybe 50% of max capacity. I also like the small town feel of the rural environment and that folks on the steet know me and wave and the bartender knows my drink and the guy at the hotel recognizes my voice on the phone and always gives me the nicest room in the place at the off season rate even in the middle of summer, etc
 
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For the record doing family practice locums I make 2-3x the pay that I do in the city because I put in more hours and I wear more hats.

In the city I generally do clinic only

In rural at a critical care access hospital that is 10 beds: I do full clinic, ER coverage, inpatient and any nursing home needs while I am there. Plus take call. Every service has a different pay rate and they all stack for major good pay.
 
For the record doing family practice locums I make 2-3x the pay that I do in the city because I put in more hours and I wear more hats.

In the city I generally do clinic only

In rural at a critical care access hospital that is 10 beds: I do full clinic, ER coverage, inpatient and any nursing home needs while I am there. Plus take call. Every service has a different pay rate and they all stack for major good pay.
fair enough. for the folks I know(both docs and PAs) doing straight ER the pay is significantly less/hr for greater responsibility, higher acuity and lower volume. I make about 15 dollars less/hr doing rural work and the docs make about 30-40 dollars less/hr.
docs at my trauma ctr urban job are lucky if they intubate or put in a central line twice/yr because there are so many folks doing it(trauma service, anesthesia, hospitalist, intensivist, residents, etc) and the medics are in general more on top of their game so fewer folks come from the field without a tube or line. at my rural job most of the docs intubate every shift and put in several central lines/week. voulme at my urban job is around 250 pts/day but with many providers at any given time. at my rural job they see maybe 40-60/day with 2 docs doing nonoverlapping 12s and a single PA on swing shift. at my urban job I frequently see 3-6 pts/hr. and admit maybe 1-2/shift. at my rural job I typically see 1-2/hr and admit many of them to the icu.
 
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fair enough. for the folks I know(both docs and PAs) doing straight ER the pay is significantly less/hr for greater responsibility, higher acuity and lower volume. I make about 15 dollars less/hr doing rural work and the docs make about 30-40 dollars less/hr.
docs at my trauma ctr urban job are lucky if they intubate or put in a central line twice/yr because there are so many folks doing it(trauma service, anesthesia, hospitalist, intensivist, residents, etc) and the medics are in general more on top of their game so fewer folks come from the field without a tube or line. at my rural job most of the docs intubate every shift and put in several central lines/week. voulme at my urban job is around 250 pts/day but with many providers at any given time. at my rural job they see maybe 40-60/day with 2 docs doing nonoverlapping 12s and a single PA on swing shift. at my urban job I frequently see 3-6 pts/hr. and admit maybe 1-2/shift. at my rural job I typically see 1-2/hr and admit many of them to the icu.

I think our ideas of what is rural are very different. At my last rural job the ER portion I saw from 2-5 patients a day in a 24 hour shift while simultaneously doing full-time clinic patients and was the only provider. I never had to intubate anyone (came close), don't have an ICU and anyone that sick would be on a medevac plane. I guess I must work EXTREME rural because that's where the pay is.
 
I think our ideas of what is rural are very different. At my last rural job the ER portion I saw from 2-5 patients a day in a 24 hour shift while simultaneously doing full-time clinic patients and was the only provider. I never had to intubate anyone (came close), don't have an ICU and anyone that sick would be on a medevac plane. I guess I must work EXTREME rural because that's where the pay is.
fair enough. the rural job in question is in a town of 10,000. nearest other hospital is 45 min away. nearest major medical ctr is 2.5 hrs away. it is classified as a critical access hospital.
 
fair enough. the rural job in question is in a town of 10,000. nearest other hospital is 45 min away. nearest major medical ctr is 2.5 hrs away. it is classified as a critical access hospital.

Yes, I work EXTREME rural then. My last job the next nearest hospital was 1 hr by plane only. Major medical center 2-3 hours by plane. Town of 3000 on an island.

Job before that, nearest hospital was 4 hours by car, 1 hr by plane. Town of 2500
 
In those instances, are you the only doc in town, Cabinbuilder? I ask because I am strongly considering doing Family Medicine and practicing in my hometown where there are only about 2-3k people. There is a small rural clinic there, but I think only one doc and one NP practice there. Can a town that size support another doc?
 
Yes, I work EXTREME rural then. My last job the next nearest hospital was 1 hr by plane only. Major medical center 2-3 hours by plane. Town of 3000 on an island.

Job before that, nearest hospital was 4 hours by car, 1 hr by plane. Town of 2500

I believe the fed govt classifies that as a "frontier setting".
I have friends who do that kind of work in the aleutians. 1 pa, 1 medic, 400 folks on the island. 3 hrs by plane to nearest hospital.
 
In those instances, are you the only doc in town, Cabinbuilder? I ask because I am strongly considering doing Family Medicine and practicing in my hometown where there are only about 2-3k people. There is a small rural clinic there, but I think only one doc and one NP practice there. Can a town that size support another doc?

Much of the time I was the only doctor just because the other 2 were off on conference or medical leave, etc. Much of the time there were 2-3 docs and a nurse practitioner. There were plenty of patients to see with ER, scheduled patients, IP, walk-in's, the nursing home. We were busy all the time. Summer was worse because of cannery workers, seasonal help for the tourist industry, the people who got sick on cruise ships, etc. I would suspect the area you are looking at may or may not have influx of other factors? Hard to know.
 
There is a Georgia Pacific plant in the town, but not much else, and the town is about thirty minutes from a larger town with good-sized hospitals. However, there are several small towns surrounding it that may provide more patients. Unfortunately, it's definitely not a tourist attraction, and there aren't really any near it.
 
The benefits of either practice have more to do with benefits of living in either of those environments. There are jobs that will overwork you in both settings. When I finally had to make this decision it had very little to do with the "job" but more where my family wanted to live. If your goal is to work for the poor...you will have no trouble doing this almost anywhere you go.
 
Yes, I work EXTREME rural then. My last job the next nearest hospital was 1 hr by plane only. Major medical center 2-3 hours by plane. Town of 3000 on an island.

Job before that, nearest hospital was 4 hours by car, 1 hr by plane. Town of 2500

Going out on a limb and guessing that last gig was in Kodiak? I remember looking at the pay rate at that hospital in comparison to rural stuff in OR, WY, ID and being really surprised at the difference. Is there different federal funding for healthcare in a "frontier setting" as opposed to just plain rural?
 
Going out on a limb and guessing that last gig was in Kodiak? I remember looking at the pay rate at that hospital in comparison to rural stuff in OR, WY, ID and being really surprised at the difference. Is there different federal funding for healthcare in a "frontier setting" as opposed to just plain rural?

No, not Kodiak. Southeast. I'm not privvy to the funding of rural hospitals. Yes, the pay rate is different being trapped on an island vs badlands in the center of the country.
 
Ah, gotcha. If you don't mind me asking, what drew you up to AK to practice? I can also PM you, if that would work better. I used to work out in Dutch and some days dream of being able to go back up there to work (definitely fits in the EXTREME rural category).
 
Ah, gotcha. If you don't mind me asking, what drew you up to AK to practice? I can also PM you, if that would work better. I used to work out in Dutch and some days dream of being able to go back up there to work (definitely fits in the EXTREME rural category).

I grew up in Alaska. Know the people, the culture. Know where it's safe for a caucasian female and where it isn't. There is always work there. My kid's dad lives there so we go back and forth all the time. It made sense to get a license so I would work while on vacation (in theory). Can be autonomous which I like. I can make a lot of money quickly so I can have more time off.
 
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