a little bit of a necro bump, I (a pharmacist) had my first job at a rural critical access hospital - and some points from my point of view.
1. We only had pharmacists (acutally pharmacist - just me) onsite 40 hours a week - so obvious issues with that. So no double checking of doses after hours, or renal dosing, etc. The guy before me got fired, and this was in one of the hardest to staff areas in the midwest - so you just don't attract the best canddiates (I was right out of school and still learning)
2. No pyxis machines, RN's just pulled meds from a sears toolbox, or went to the pharmacy - and pulled meds- many times the wrong ones.
3. Most of the non-physician employees grew up in said town - they might have been well intentioned, but they weren't the most up on the newest literature/info if you know what I mean. See #1 about attracting quality employees.
4. No specialist available for inpatients.
5. Many of these types of towns are not for everybody - actually not for most people, mine was a dirt poor meth infested town with 3 meth house explosions in the one year I was there (town had 5,000 people). Depending on the person, often many of the towns down always like outsiders, although being a doctor, you usually get a pass on this one.
6. We had 6 doctors in town, four were related, 4 were all over the age of 65. They were nice, but I wouldn't trust the four older ones to take care of most people - they were just so out of touch with updated guidelines. The two younger ones left after only a couple of years for a bigger city.
7. When **** hits the fan, it hits the fan, like when we had dueling codes in the ED with one doc, or 3 traumas show up at once in a four room ED.
I am glad I worked there- but it was only a little over a year and moved on to a typical tertiary care center in an urban area
As a rheumatologist who moved from the urban Midwest to work in PP in the semi-rural south, I can echo a lot of what you experienced. I see a lot of things on a day to day basis that may be pretty surprising if you’re coming from typical large urban areas:
- Do not expect your colleagues to be members of the medical A-team. Your colleagues may have had board actions against them, may be in the state PHP for drug and alcohol abuse, etc. I totally agree that you don’t attract the best candidates in these areas…which leads to my next point:
- The quality of medicine you see practiced may range from simply “behind the times” to “shockingly incompetent”. For instance, in my specialty on a regular basis I see cowboy PCPs starting methotrexate without folic acid in patients who have never had hep screenings or a CBC; people who are talking two benzos at once for unclear reasons, with a cocktail of opioids, stimulants, and other controlled substances to boot; and on and on and on. Even as a specialist you will clean up weird messes of basic medicine that never, ever should have happened. If myself or my family fell ill, there are very few local docs I would trust my family to see. If you have to refer your own patients to other specialists, you might not find any you can trust. This leads to the next issue, which is:
- If you’re “too good” of a doctor by the local standards, some of the less competent colleagues around you may feel intimidated - and they may start inventing weird reasons as to why you “don’t belong there”, (no joke, I’ve seen it happen). If an actual good physician ends up in these locales, they often don’t last long before moving on - and sometimes they literally get run out of town by local providers who don’t want superior competition.
- Agree that weird local hospital politics is an issue too. In my town, the local hospital system has had a longstanding and stupid “Cold War” with my multispecialty practice over completely pointless things…as a new doc I’m basically expected give a damn about this weird conflict that I don’t care about at all, and support our side in this thing. It’s really pointless.
- Agree that the “talent pool” for local office staff is simply awful. MAs, nurses, and other staff often don’t have the greatest work ethic, aren’t well trained, etc etc.
- As stated above, don’t expect the locals to necessarily be super happy about you as an “outsider” being there…but they’ll usually give you a pass for this as a doctor because they realize that it’s hard to draw doctors to town.
The pay is better in rural areas but there’s a lot of drawbacks.
