What is life like in rural practice?

[Signifier]

Hi all,

I am currently working as a teacher but I intend to enter medical school in 2012. I have long wanted to work as a physician, but even longer wanted to work in a rural practice. I was born and grew up in a rural area, and want nothing more than to return to a rural area to work. (Also, during undergrad I had a lot of EC experience volunteering in rural healthcare settings).

I am posting here in this... well, almost-entirely-dead forum, to ask about your experience in rural medicine. What is your life like? How hard was it for you get your job? Would you recommend rural practice? What wisdom can you share about it?

This doesn't have to just be from practicing docs... anyone with any knowledge or experience... please share out!

---

Members don't see this ad.

 

[MJB]

Hi all,

I am currently working as a teacher but I intend to enter medical school in 2012. I have long wanted to work as a physician, but even longer wanted to work in a rural practice. I was born and grew up in a rural area, and want nothing more than to return to a rural area to work. (Also, during undergrad I had a lot of EC experience volunteering in rural healthcare settings).

I am posting here in this... well, almost-entirely-dead forum, to ask about your experience in rural medicine. What is your life like? How hard was it for you get your job? Would you recommend rural practice? What wisdom can you share about it?

This doesn't have to just be from practicing docs... anyone with any knowledge or experience... please share out!

I grew up in and have rotated with a few docs that practice in rural areas...what I can tell you is that if you are SURE this is what you wanna do, you can write your own ticket, and there are a TON of job/practice opportunities out there...you can literally work as much or as little as you want it seems. Meaning you can be a workaholic and get school paid for or work a really reasonable schedule and still get your school paid for...I'd explore options...to stay away from Student loans...they are the devil.

 

[Signifier]

Thank you for your reply. One thing I sometimes wonder about: what are the main reasons docs don't go into rural practice?

I can imagine a few but I'd like to hear from someone else. Once a practice is established, it seems like rural offers several distinct advantages over urban. Perhaps that is just the way my soul works, though - I teach in an inner city school, and waking up to a loud, smoggy, crowded city every day is utterly mind destroying.

Thoughts/experiences welcome. Oof! Why doesn't this place have more activity?

 

[digitlnoize]

Thank you for your reply. One thing I sometimes wonder about: what are the main reasons docs don't go into rural practice?

I can imagine a few but I'd like to hear from someone else. Once a practice is established, it seems like rural offers several distinct advantages over urban. Perhaps that is just the way my soul works, though - I teach in an inner city school, and waking up to a loud, smoggy, crowded city every day is utterly mind destroying.

Thoughts/experiences welcome. Oof! Why doesn't this place have more activity?

3rd year med student here, so I don't actually know what I'm talking about.

I think a big issue for most people is that they don't want to go TOO rural. For example, I really like smaller towns, but they can't be too small. It's gotta have some culture, a couple movie theaters, some type of music scene, some good restaurants, and a Walmart or, preferably, Target. I definitely agree with your assessment of large cities. Hate the traffic, crime, pollution, crowding, etc.

I'm originally from Charlottesville, VA, so if that gives you any idea about the type of place I like, there you go. I've been to (and grew up in) some of the REALLY rural places in Virginia, and they're literally hours from anything. When you have to drive an hour to get to the nearest grocery store...that's rural. So, that's a barrier. The other issue is that many of these jobs are in the rural midwest, which is a long way from home for most of us. Also, I'm scared to death of tornadoes. Hurricanes you can predict, but tornadoes...scary stuff.

Ideally, I could deal with living in a smallish town like Charlottesville, but practicing about a half hour outside town in a mural rural community (or vice versa, really). But, I'm not about to drive an hour a day to work, grocery, or civilization.

Anyways, just some of my insights.

 

[cabinbuilder]

Thank you for your reply. One thing I sometimes wonder about: what are the main reasons docs don't go into rural practice?

I can imagine a few but I'd like to hear from someone else. Once a practice is established, it seems like rural offers several distinct advantages over urban. Perhaps that is just the way my soul works, though - I teach in an inner city school, and waking up to a loud, smoggy, crowded city every day is utterly mind destroying.

Thoughts/experiences welcome. Oof! Why doesn't this place have more activity?

I LOVE rural medicine. Get to do whatever you are comfortable with. You can do OB or not OB. Casting, injections, work ER,you name it.

The main reasons I left a rural practice in Montana was the lack of housing, the lack of employment for my spouse and the lack of educational opportunities that my kids needed coming from a prior 5A school. Plus I have a son who was in advanced math, science, and music skills who needs that extra challenge that we didn't get in Montana and he was bored.

I just did a locums stint in rural Texas for 12 weeks - LOVED it but didn't stay because the education opportunity just isn't there and I want to be where my kids get the maximum out of their education as possible.

I am from rural Alaska and would go back in a minute if the education opportunities weren't what they are (I am a product of the Alaskan school system) and know how hard it is to get to do what you want.

So the thing about rural practice is if your family isn't happy - for me it wasn't worth it. All this talk about student loan repayment is bogus - OBAMA changed a lot of that. I never have gotten help with student loans through any state or federal program and trust me I have applied to all of them. However, I do make enough that the payments are not difficult to make.

Another issue I had with rural practice is that you may not get the autonomy you think you should have. Many rural jobs are employee/salary so you are looked upon by admin as equal as the janitor and HAVE NO SAY about your life or your practice. That happened to me in one of the rural sites I was in. I was worked like a dog and treated worse. Was able to get out due to breach of contract by my employer and walked away.

I agree with one of the above posts - there are TONS of rural jobs out there but if you have a family it may not be ideal. If you are single, or childless it may be more appealling.

I hope that clears up some things for you.

 

[Random Anesthesiologist]

I am from rural Alaska and would go back in a minute if the education opportunities weren't what they are (I am a product of the Alaskan school system) and know how hard it is to get to do what you want.

Are you bashing or praising the AK school system here? You did become a physician and all, being a product of the AK system.

 

[DrYoda]

Are you bashing or praising the AK school system here? You did become a physician and all, being a product of the AK system.

There's a few people that make it in every group. I wouldn't put my kids in the school district I went to either, even though I've done well academically.

 

[cabinbuilder]

Are you bashing or praising the AK school system here? You did become a physician and all, being a product of the AK system.

Neither, but I have a kid who if off the scale academically so he needs that extra challenge. Difficult when you are the best student in a class size of 10like I was to get that challenge. Huge scramble to keep up in college because I never had the need to study or be challenged in school. Actually finished high school in 3 yrs since it was so easy. I travelled the other year. Yes, I became a doctor because I didn't quit, got tutors, and it damn sure wasn't a piece of cake to get through college. It was a major effort all the way and I had wished in the end that I had been better prepared coming out of high school despite having a 4.0. Didn't really mean all that much.

 

[Prncssbuttercup]

I have delusions (or I think they are) of being able to practice rural medicine and being able to ride my dirt bike to work... or a horse, or snowmobile... etc... but it won't be in Walsenburg CO...

 

[MLT2MT2DO]

I have delusions (or I think they are) of being able to practice rural medicine and being able to ride my dirt bike to work... or a horse, or snowmobile... etc... but it won't be in Walsenburg CO...

Riding a horse to and from work and to house calls would be a deal clincher for me.

I think I watched too much Little House on the Praire growing up

 

[Anam Cara]

To quote the philosopher, "I know that I know nothing" regarding rural medicine.

However, an interesting book entitled The Country Doctor Revisited provides some insights into rural medical practice. It is a collection of essays written by physicians regarding their rural experiences. You may find it interesting... and possibly helpful.

I'm a long way before even needing to think about what it would be like to practice family medicine in a rural context, but I've always been curious about it. I'm about 2/3 through the book and can say that it's been illuminating.

Anywho, well wishes to you as you consider what your work as a healer will be like.

 

[kirbyross]

I LOVE rural medicine. Get to do whatever you are comfortable with. You can do OB or not OB. Casting, injections, work ER,you name it.

The main reasons I left a rural practice in Montana was the lack of housing, the lack of employment for my spouse and the lack of educational opportunities that my kids needed coming from a prior 5A school. Plus I have a son who was in advanced math, science, and music skills who needs that extra challenge that we didn't get in Montana and he was bored.

I just did a locums stint in rural Texas for 12 weeks - LOVED it but didn't stay because the education opportunity just isn't there and I want to be where my kids get the maximum out of their education as possible.

I am from rural Alaska and would go back in a minute if the education opportunities weren't what they are (I am a product of the Alaskan school system) and know how hard it is to get to do what you want.

So the thing about rural practice is if your family isn't happy - for me it wasn't worth it. All this talk about student loan repayment is bogus - OBAMA changed a lot of that. I never have gotten help with student loans through any state or federal program and trust me I have applied to all of them. However, I do make enough that the payments are not difficult to make.

Another issue I had with rural practice is that you may not get the autonomy you think you should have. Many rural jobs are employee/salary so you are looked upon by admin as equal as the janitor and HAVE NO SAY about your life or your practice. That happened to me in one of the rural sites I was in. I was worked like a dog and treated worse. Was able to get out due to breach of contract by my employer and walked away.

I agree with one of the above posts - there are TONS of rural jobs out there but if you have a family it may not be ideal. If you are single, or childless it may be more appealling.

I hope that clears up some things for you.

Thanks so much. That was a big concern for me is my wife and kids. I feel good about the job opportunity for me, but hesitant about the lifestyle/opportunities for my wife and kids.

There's still plenty of talk on loan forgiveness...what do you mean Obama changed it? I can't really keep on top of my own coursework, let alone politics, but can someone give me a 2 sentence summary of what the current loan forgiveness opportunities that are out there?

I've looked at the NHSC website, and it still appears to be in full force.

What do you mean you applied to all of them but never got any benefit?

Thanks so much

 

[kirbyross]

Neither, but I have a kid who if off the scale academically so he needs that extra challenge. Difficult when you are the best student in a class size of 10like I was to get that challenge. Huge scramble to keep up in college because I never had the need to study or be challenged in school. Actually finished high school in 3 yrs since it was so easy. I travelled the other year. Yes, I became a doctor because I didn't quit, got tutors, and it sure wasn't a piece of cake to get through college. It was a major effort all the way and I had wished in the end that I had been better prepared coming out of high school despite having a 4.0. Didn't really mean all that much.

I did the same thing. Cruised through high school half asleep, and then got shell shocked in college...but persistence has paid off so far.

Thanks for sharing; I'm glad I wasn't the only one who went through that experience of a small town high school...

 

[RecruitMRHC]

I'm Cissy, Physician Recruiter for Magnolia Regional Health Center in Rural Mississippi, Corinth, MS to be exact. I wouldn't say I'm from a Metropolis, however Corinth is much smaller than what I am used to, 14,000 people in the town, 34,000 in the county, and drawing area of 7 counties equalling about 110,000 people. If the smog, noises and people are making you crazy, the slower way of life can be quite refreshing. Rural Healthcare in general has tons of opportunity for practicing physicians. You can skip the commute, which leads to more family time. It offers a great family-friendly atmosphere and sense of community and belonging. We are classified as a MUA, so deciding to work here helps fill the need for accessable health care for a lot of people. We also offer loan repayment, recruitment bonuses, stipend programs, and a lucrative salary. Rural living isn't for everyone....but it sounds like it is for you.

 

[digfast]

---------

 

[onewithpain]

In my mind it would be hard to be too rural, as long as I can find work. I have to balance that with my wife's desire which was to be in a town of about 100,000. We always went on vaction in rural places and when we had a daughter my wife downsized her desire a bit and then went a bit further for the sake of loan repayment. I started here on the coast of southern Oregon in 2007 and got 2/3 of my loans repayed by the state and the local hospital picked up the rest. The state gives us a tax credit and subsidizes our malpractice for being rural. I have complete autonomy over my practice and when I started here my agreement was to do FM, OB and ER. I had a lot of training in pain and so I made it clear that I would be doing that as well. Shortly after starting here my group hired an anesthesiologist to do pain and so I felt a little slighted, but the FM bedside manner prevailed and the anesthesiologist left. Since then 2 other pain practitioners in the county have left and so I am the last one standing. I do my procedures at the small hospitals in the area as they can collect an extra 25% from medicare and they have 90% or better reimbursement rates negotiated with the privates. These agreements were all negotiated by myself independently, but I continue to work under the umbrella of my group for the support that they provide. Financially I have heard of some better deals in Nevada in the mining towns, but those are subsidized by the local industry. We are in a county of ~90,000 and we do have a Walmart, but shopping is a weak point. UPS delivers and its about 2.5 hours to a town of about 150,000. Fresh fish is cheap and we put about 140 lbs of halibut, salmon and tuna in the freezer last summer, with more in cans. The schools are probably not as challenging as in the city, but there is a charter school that a lot of the docs send their kids to and my 6 yo daughter loves the school and the area. We feel that it is important for her to see the city and so we travel when time allows. My wife has a close circle of friends and has admitted that life is good here. The economy and culture seems to be stuck in the past when logging and fishing ruled, but it is shifting in that a lot of people retire here and the local golf resort is rated above Pebble Beach. In my mind, when looking for a rural site look for places that you would like to live or vacation, then look for work there. You have to be a bit of a salesman and the merchandise is you. Your reputation can bring in a lot of business and it seems that whenever we go out I see several of my patients. I like it like that.

 

[MJB]

In my mind it would be hard to be too rural, as long as I can find work. I have to balance that with my wife's desire which was to be in a town of about 100,000. We always went on vaction in rural places and when we had a daughter my wife downsized her desire a bit and then went a bit further for the sake of loan repayment. I started here on the coast of southern Oregon in 2007 and got 2/3 of my loans repayed by the state and the local hospital picked up the rest. The state gives us a tax credit and subsidizes our malpractice for being rural. I have complete autonomy over my practice and when I started here my agreement was to do FM, OB and ER. I had a lot of training in pain and so I made it clear that I would be doing that as well. Shortly after starting here my group hired an anesthesiologist to do pain and so I felt a little slighted, but the FM bedside manner prevailed and the anesthesiologist left. Since then 2 other pain practitioners in the county have left and so I am the last one standing. I do my procedures at the small hospitals in the area as they can collect an extra 25% from medicare and they have 90% or better reimbursement rates negotiated with the privates. These agreements were all negotiated by myself independently, but I continue to work under the umbrella of my group for the support that they provide. Financially I have heard of some better deals in Nevada in the mining towns, but those are subsidized by the local industry. We are in a county of ~90,000 and we do have a Walmart, but shopping is a weak point. UPS delivers and its about 2.5 hours to a town of about 150,000. Fresh fish is cheap and we put about 140 lbs of halibut, salmon and tuna in the freezer last summer, with more in cans. The schools are probably not as challenging as in the city, but there is a charter school that a lot of the docs send their kids to and my 6 yo daughter loves the school and the area. We feel that it is important for her to see the city and so we travel when time allows. My wife has a close circle of friends and has admitted that life is good here. The economy and culture seems to be stuck in the past when logging and fishing ruled, but it is shifting in that a lot of people retire here and the local golf resort is rated above Pebble Beach. In my mind, when looking for a rural site look for places that you would like to live or vacation, then look for work there. You have to be a bit of a salesman and the merchandise is you. Your reputation can bring in a lot of business and it seems that whenever we go out I see several of my patients. I like it like that.

Thank you so much for your post. As a person getting into the field, I'm always interested in the different opportunities that await our family. May I ask how you found this opportunity, and perhaps more about what your typical day/week entails?

I would LOVE to be able to pull off a full scope practice, but don't want to sacrifice a lot of family time to do so. To me, the perfect balance would be able to have a full scope practice with plenty of family time...and I know that's going to be hard to do.

 

[onewithpain]

As a medical student and resident the first thing that I looked at when I opened a journal was the classified ads. I found this job in the American Family Physician. My wife liked the spot so I gave a verbal commitment as a second year resident. But I wouldn't limit myself to the 'want ads'. As an intern I would call hospitals in places that I had lived in and liked in order to describe my situation and the feedback was overwhelmingly positive. I almost had my wife sold on Salmon, Idaho. The hospital CEO was going to fly us out and show us the town and set up a float trip, so I told my wife how idyllic the town was and described the airport and nice gravel runway which I had flown into in the past. I should have skipped the gravel part because that's where I lost her. So I tell people that the reason we're here is because they have a paved runway. When I look around this area, doctors are needed everywhere but no one seems to advertise. They bring in candidates through a head-hunter and some seem like good candidates. A cold-call really gets attention because it signifies that you have the desire as well as the resourcefulness to get what you want.

My work week as a pain medicine provider is ideal. 5 days, 8-9 hours/day. I recently spent a ton of my spare time studying for the ABPM exam, and I try to get 2 cadaver classes each year. I spend 2 days in the town where I live, then the other 3 days are divided between 3 other towns all about 30 minutes away. When I was a PCP and fulfilling my initial obligation my days were longer as there was more paperwork, and I took ER and OB call. I liked the call work and saw some great stuff, but I like being home with my family at night and weekends more than the call. I started undergrad when I was 40 and so I'm sure that age contributes to my intolerance of sleep deprivation.

We really do have a good financial arrangement here and I don't know how easy it would be to replicate elsewhere. The group functions as a coop and provides support and guidance. We pay anywhere from 17-22% of our collections to the group (12% if your moonlighting or taking call) and then we pay our expenses including an MA(s). I have been able to keep 60% of my collections in the past and that should improve as I get more efficient. When you interview its good to let your needs be known. There are places where the full scope is possible and it is enjoyable, but you can make more if you concentrate on our clinic and you can more easily limit your schedule.

 

[Prncssbuttercup]

100k people is NOT a small town! I'd be happy with 10k, maybe 20k, and it could be 25 minutes away... not a problem... If I can ride my dirt bike, that's better still. I have found that I can have all that I need shipped to me via Amazon. As long as the apocalypse doesn't happen before I finish (or get into) school, I'm golden... My husband may go stir crazy, not sure, but I have a feeling he would find something to do (he's very mechanically inclined and could easily start a small repair business)...

I watched tons of Little House on the Prairie, and personally, if I could make ends meet doing it, would be happy to take trades for services... however, I don't know that it would pay my house payment... Either way, I want to do it... like I said, it just won't be in Walsenberg... Maybe Fairplay, CO...

 

[goprisko]

My wife and I are very interested in shifting to SW Oregon upon completion of her
residency. We were stationed at a rural hospital in Northern Namibia for two years, where
virtually all patients were Ovambo or Himba, the local indigenes. We very much liked
the collegiality of the place. Prior to that we were stationed in Shenzhen China where I was
dean of international programs at Shenzhen University. Prior to that my wife practiced in Siberia.

The interest in SW Oregon comes from the Climate. Medford seems to have hot summers, which my wife wants. I am a yachtsman who sailed world wide, and it appears there are
several harbors for the ship.

My wife has no student debt, whatever, so that is not a factor. She trained in Infectious Diseases in Russia, and went to Africa to see some real bugs. She is now in a Categorical IM residency in NYC. It was the only one that would take her, because she was >10 years since graduation. Her test scores and LORs are excellent.

I've tried to interest her in Vancouver Island, Nainamo in fact, but she thinks the summers are too cool.

Washington State seems too cloudy and damp for me.

Now to the point, we'd like to organize a trip to the area to meet several prospective employers, and to get to know it first hand. Can you be of assistance in this?

Also, the financial situation at her hospital is uncertain, they are in Ch11. Are there residency programs in the NW she should look into?

INDY

 

[cabinbuilder]

My wife and I are very interested in shifting to SW Oregon upon completion of her
residency. We were stationed at a rural hospital in Northern Namibia for two years, where
virtually all patients were Ovambo or Himba, the local indigenes. We very much liked
the collegiality of the place. Prior to that we were stationed in Shenzhen China where I was
dean of international programs at Shenzhen University. Prior to that my wife practiced in Siberia.

The interest in SW Oregon comes from the Climate. Medford seems to have hot summers, which my wife wants. I am a yachtsman who sailed world wide, and it appears there are
several harbors for the ship.

My wife has no student debt, whatever, so that is not a factor. She trained in Infectious Diseases in Russia, and went to Africa to see some real bugs. She is now in a Categorical IM residency in NYC. It was the only one that would take her, because she was >10 years since graduation. Her test scores and LORs are excellent.

I've tried to interest her in Vancouver Island, Nainamo in fact, but she thinks the summers are too cool.

Washington State seems too cloudy and damp for me.

Now to the point, we'd like to organize a trip to the area to meet several prospective employers, and to get to know it first hand. Can you be of assistance in this?

Also, the financial situation at her hospital is uncertain, they are in Ch11. Are there residency programs in the NW she should look into?

INDY

Careful setting up shop in Oregon. The state income taxes along with federal taxes are not nice to have to pay. I found that out the hard way. Added 25K in taxes for me this year. I am getting out of Oregon and going to a state income tax free state. BTW, Oregon is very damp too. Portland is very cloudy as well.

 

[primadonna22274]

CB is right but southern Oregon is vastly different culturally and weather-wise from Portland. The weather is a bit milder and more sunshine days but still harsh winters. There is almost nothing to do culturally in Medford although Ashland is nearby and that's an awesome place to visit
You will not find much diversity AT ALL in southern Oregon.
If you want to sail, have great weather year-round, have CHEAP cost of living and VERY cheap state taxes, consider the Carolinas. Charleston is a bit expensive compared to the rest of the state but with no debt you are in a fantastic position to enjoy life. The spectrum of disease is fascinating (growing up in Oregon, I never saw "sick" until I moved to the south!!) and MUSC is a major medical school and regional training center if she has any interest in academics. There is quite a bit more diversity and culturally the area is very exciting.
Good luck!!

 

[goprisko]

Hi,

Thank you for the information regarding Oregon and the Carolinas.

I actually have sailed extensively in the Carolinas, and liked Elizabeth City very much.

I also discovered that NC has an extensive AHEC network and the eastern shore is considered medically under served.

Can anyone comment on the Carolinas vs underserved areas of Florida. I note for example that the Keys are underserved, and much of the north of Florida likewise. Since we are speaking of the SE which of these states is more likely to accept an immigrant?

INDY

 

[goprisko]

Hi,

Thank you for the information regarding Oregon and the Carolinas.

I actually have sailed extensively in the Carolinas, and liked Elizabeth City very much.

I also discovered that NC has an extensive AHEC network and the eastern shore is considered medically under served.

Can anyone comment on the Carolinas vs underserved areas of Florida. I note for example that the Keys are underserved, and much of the north of Florida likewise. Since we are speaking of the SE which of these states is more likely to accept an immigrant?

INDY

Hi,

Thank you for the information regarding Oregon and the Carolinas.

I actually have sailed extensively in the Carolinas, and liked Elizabeth City very much.

I also discovered that NC has an extensive AHEC network and the eastern shore is considered medically under served.

Can anyone comment on the Carolinas vs underserved areas of Florida. I note for example that the Keys are underserved, and much of the north of Florida likewise. Since we are speaking of the SE which of these states is more likely to accept an immigrant?

INDY

 

[styphon]

I am kind of rural, practice in a very low density area with very few doctors or specialists. But we are 1hr outside of city with a major medical industry.

I enjoy it, I get to do more than I would in the city. The city has a overflow of OB/GYNs, who also fully staff the board that gives L&D privileges, so it would be hard to practice OB in the city.

The same with pediatrics, it is dominated by pediatric practices and would be hard to practice without OB/GYN or nursery privileges.

 

[Mt Kilimanjaro]

So the thing about rural practice is if your family isn't happy - for me it wasn't worth it. All this talk about student loan repayment is bogus - OBAMA changed a lot of that. I never have gotten help with student loans through any state or federal program and trust me I have applied to all of them. However, I do make enough that the payments are not difficult to make.
.

Just stumbled across this thread. I'm curious why you have found the loan repayment programs to be hard to come by. My impression has always been that these programs are there for the taking, with the exception of the NHSC scholarship which is fairly competitive.

 

[cabinbuilder]

Just stumbled across this thread. I'm curious why you have found the loan repayment programs to be hard to come by. My impression has always been that these programs are there for the taking, with the exception of the NHSC scholarship which is fairly competitive.

Well, guess, again. That was may impression too. I haven't seen a dime. Applied to 5 different programs. Got tired of all the paperwork just to be turned down yet again. Got fed up and went to locums so don't qualify anymore. I applied to scholarships in Montana and Colorado too. THEY ARE ALL COMPETIVE. Don't kid yourself.