Rural vs. Urban Primary Care Incomes

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I have heard that FM docs can make a nice living doing rural medicine. I recently came across this article that basically refuted every benefit that I have heard about FM in a rural setting.

"A recent article (April 2008) by William B. Weeks, MD, MBA and Amy E. Wallace, MD, MPH, that appeared in the Journal Of Rural Health compares the practice patterns and incomes of primary care physicians in rural versus urban areas and these were the findings:

"Rural primary care physicians' unadjusted annual incomes were similar to their urban counterparts, but they tended to work longer hours, complete more patient visits, and have a much greater proportion of Medicaid patients."

"After adjusting for work effort, physician characteristics, and practice characteristics, primary care physicians who practiced in rural settings made $9,585 (5%) less than their urban counterparts"

"In particular, rural practicing general internists and pediatricians experienced lower incomes than did their urban counterparts."
, possibly mostly due to the fact that the rural docs accept more of the low-paying Medicaid and Medicare patients..."

Abstract/article here: http://www.blackwell-synergy.com/doi...1.2008.00153.x

What do you guys think? I know some will come on here to defend rural FM since that is what they want to go into. I am also interested in rural FM, but I would like some more objective data rather than the usual "I have heard" comments. This is the most objective study that I have read, just not sure if it answers all the questions.

I'm just an incoming med student this year, so I may not be right on this, but the article also mentions that the two specialties showing the largest difference were general internists and pediatricians. I'm under the impression that FP's are able to do more procedures in rural settings than they would in an urban area. FP's actually made up less than 20% of the docs studied in this paper and may actually fair better than the PCP group when looked at as an individual specialty.

The bottom line is that no matter how busy you are, you still need to look after the bottom line (assuming you're not on some kind of guaranteed salary).

If you're one of only a handful of docs in town, you'll likely feel more pressure to accept all insurance plans, no matter how poorly they reimburse (e.g., Medicare, Medicaid). You'll also likely see a lot more uninsured patients and "charity care." The typical small-town environment makes it more difficult to dismiss patients from your practice for non-payment, so you'll probably find yourself writing off a lot. All of this adds up.

Most of the physicians that I've heard of who were having difficulty make ends meet were working in rural/underserved areas.

I'm not knocking rural practice. However, the money's not going to fall in your lap any more easily out in the country than it will in town. To maintain a decent income relative to your peers, you're going to have to work smart, just like anyplace else.

Originally Posted by KentW

Most of the physicians that I've heard of who were having difficulty make ends meet were working in rural/underserved areas.

I'm not knocking rural practice. However, the money's not going to fall in your lap any more easily out in the country than it will in town. To maintain a decent income relative to your peers, you're going to have to work smart, just like anyplace else.

This is what I am also starting to believe. I have been told that "Rural FM is so great.... You can make 2x as much as working in a suburban/urban area...etc." After doing some research, reading this article, and talking to some practicing physicians, the truth seems to be more gray than what others have made it out to be. I wish it would be as easy as setting up shop in a rural area and easily get well compensated. But as the article shows, this isn't quite the case.

It seems like this would be less of a problem if you went to a rural area with an already established, successful practice. It would be difficult (I think) for a physician to be starting a new practice in an underserved area for this reason. (especially if this were the first time they had set up a practice)

Originally Posted by HarveyCushing

"After adjusting for work effort, physician characteristics, and practice characteristics, primary care physicians who practiced in rural settings made $9,585 (5%) less than their urban counterparts"

Interesting find. From what I've been told (asking a couple of small town physicians near where I grew up) they seem to think that rural physicians make more in absolute income but less per hour than their urbanite counterparts.

The consensus seems to be that in rural areas, a physician tends to have a lot more call and work longer hours. The prevalence of Medicare and uninsured patients tends to be balanced out by being one of only a handful of people in the county who can deliver a baby.

This is an interesting thread and it really makes a good point. However, I'm not really sure how to interpret the numbers in the study. I think the issue is a little more complicated than urban/rural. If you have a heavy Medicaid population, then you will make less money per hour no matter where you live. In some states, Medicaid reimburses more if your practice is designated rural. That doesn't really make up for the generally poor rates, but it can make a difference.

How do you define rural? There is a huge difference between a town so small as to support only one or two physicians, and a town that is "rural", but supports 30. How do you factor in cost of living differences?

One thing is true regardless, rural physicians do typically work longer hours with more call.