Is rural worth it?

[jordansetron]

Some people in my class have been talking about practicing in a rural area once they get picked up by a medical group. Other people have the idea that practicing in a rural area is the worst thing that could ever happen to a physician. The argument from the pro-rural doctors is that they would make more money and their money would go farther, allowing them to pay off their loans and establish some wealth early. If they really dont like it they feel as though they can simply move somewhere else once their contract runs out.

What are some of your thoughts on the pros and cons? Is it true that rural physicians working for a medical group are compensated more (fields like EM, IM, etc) than "urban" physicians? What is considered "rural" anyway? What is the marginal increase in compensation? Is it relatively easy for a physician to just pack up and move to another hospital?

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[Drrrrrr. Celty]

You can make more money.

However the question is whether you want live in a rural environment.

 

[Mad Jack]

Whether rural work is for you or not is a personal decision. One man's heaven is another man's hell, as it were. Personally I'll take a rural practice environment over a city one any day, because I'm not paying a fortune to be packed up with a few million other people like a sardine in a can. If you like the outdoors, peace and quiet, actually being a member of a community that knows you, having both an excellent income and a low cost of living, and serving a community as an integral member rather than a replaceable cog, rural medicine might be for you. The tradeoff you make is that you lose many of the draws of city life and big city medicine- nightlife, a large population and variety of people to interact with, massive variety in everything from food to shopping, decent-to-excellent private schools for your kids, the prestige that comes with being a physician at a big medical center, research funding, academic positions, etc. No one can say whether it is right for you or not.

As to rural, generally that's defined by population density. There's micropolitan, metropolitan, and rural definitions frequently used by the US government. Many people that are used to big city life would consider micropolitan areas rural, as they usually have one population cluster of less than 50,000 people surrounded by a cluster of small rural towns. Here's a map for reference.

There's no hard and fast definition for rural that everyone accepts equally, as what rural is to a city dweller is very different than what rural is to a person that grew up in a town of 20,000.

As to whether rural docs earn more- they earn the same or better than their city-dwelling counterparts with substantially less money used on cost of living. Overall, this amounts to paying down loans and saving for retirement significantly faster. Plus you're much less likely to have that instinct to keep up with the Joneses when you're living in the sticks, so your spending on non-essential things tends to not be as high.

 

[Danglebells]

if you are talking about up and moving as a Family Practice doc, you are underestimating how much hard work and time goes into building a practice. In theory, the jobs are everywhere... but primary care is tough to just up and leave when your patients don't move to a new town with you.

 

[IslandStyle808]

I think the one thing I would be worried about is dealing with less diversity of cases. I don't think that is too much of an issue in towns of 30,000 and above. However, worrisome for those below that number. If one wanted to practice in a bigger city after sometime, they may have a tougher time trying to deal with a "zebra." This is probably conjecture on my part.

 

[Mad Jack]

if you are talking about up and moving as a Family Practice doc, you are underestimating how much hard work and time goes into building a practice. In theory, the jobs are everywhere... but primary care is tough to just up and leave when your patients don't move to a new town with you.

I'm betting he's talking more about employed positions- most premeds aren't thinking far enough ahead to worry about practice startup troubles, costs, etc.

 

[Mad Jack]

I think the one thing I would be worried about is dealing with less diversity of cases. I don't think that is too much of an issue in towns of 30,000 and above. However, worrisome for those below that number. If one wanted to practice in a bigger city after sometime, they may have a tougher time trying to deal with a "zebra." This is probably conjecture on my part.

It's funny, but you'll actually encounter more zebras in a lot of rural places than you will in big cities. Two big areas that come to mind are Amish PA and northern ME (which has a large group of relatively isolated French-Canadian descended individuals), both of which have suffered from a lack of genetic diversity leading to a great number of weird things being seen on a regular basis. The overall number of cases in these communities may be lower, but the percentage of zebras is higher.

https://en.wikipedia.org/wiki/Jumping_Frenchmen_of_Maine
http://blog.eogn.com/2014/10/03/att...u-inherit-oculopharyngeal-muscular-dystrophy/
http://www.cbc.ca/news/canada/montreal/french-canadian-disease-prompts-u-s-warning-1.1201906
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077314/

 

[IslandStyle808]

It's funny, but you'll actually encounter more zebras in a lot of rural places than you will in big cities. Two big areas that come to mind are Amish PA and northern ME (which has a large group of relatively isolated French-Canadian descended individuals), both of which have suffered from a lack of genetic diversity leading to a great number of weird things being seen on a regular basis. The overall number of cases in these communities may be lower, but the percentage of zebras is higher.

https://en.wikipedia.org/wiki/Jumping_Frenchmen_of_Maine
http://blog.eogn.com/2014/10/03/att...u-inherit-oculopharyngeal-muscular-dystrophy/
http://www.cbc.ca/news/canada/montreal/french-canadian-disease-prompts-u-s-warning-1.1201906
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077314/

That is actually a good point...

It is weird that a lot of us on here equate a larger hospital to greater pathology. Yet there are more zebras in these areas. In your opinion are rural hospital equipped enough to deal with most zebras or is it best left to academic centers?

 

[Mad Jack]

That is actually a good point...

It is weird that a lot of us on here equate a larger hospital to greater pathology. Yet there are more zebras in these areas. In your opinion are rural hospital equipped enough to deal with most zebras or is it best left to academic centers?

Depends on the disease. In Maine, generally it's up to the GP/FM doc in the middle of nowhere to identify it, after which they call in a consult to someone that may or may not have more experience at the major referral center of the state. If it's something they can manage with basic guidance, they do so, if not, the patient gets referred out for a big workup at the regional medical center with routine care to be further provided by their PCP. But a lot of the genetic diseases you see around here that would be zebras anywhere else in the country become highly predictable, such as the lipid processing deficiency many French Canadian descended Mainers have- you just learn what a zebra looks like in your area and adapt to hunting it. You might still miss the really, really weird ****, but at least you'll catch the stuff that's plaguing your community.

 

[Mad Jack]

Oh, and that's totally leaving out the interesting and odd diseases that tend to come from rural, impoverished areas that you don't see nearly as much in wealthy areas. Coal miner's lung (and all the other restrictive lung diseases that come with working in mines), CJD and other diseases acquired from eating hunted meat, and much, much more. A lot of rural areas have more in common with practicing in developing countries than they do with practicing in the big city- there's a lot of weird injuries, pathology, and genetic diseases that you just don't get the same concentration of if you're a FM doc in NYC.

 

[Jinxapotato]

I also heard rumor that the more rural it gets, the bigger your salary cheque (I knew a Canadian FM physician who works waaaay up north, and he makes 300k per 6 months or something like that) . Anyone wanna clarify on this?

 

[IslandStyle808]

Oh, and that's totally leaving out the interesting and odd diseases that tend to come from rural, impoverished areas that you don't see nearly as much in wealthy areas. Coal miner's lung (and all the other restrictive lung diseases that come with working in mines), CJD and other diseases acquired from eating hunted meat, and much, much more. A lot of rural areas have more in common with practicing in developing countries than they do with practicing in the big city- there's a lot of weird injuries, pathology, and genetic diseases that you just don't get the same concentration of if you're a FM doc in NYC.

So it is more like there are a higher concentration of certain types of zebras in rural areas. However, there is a greater variety of zebras in urban area, but the concentration of them is very low (in part because they are referred to these urban hospitals). Am I correct in assuming this?

 

[Mad Jack]

So it is more like there are a higher concentration of certain types of zebras in rural areas. However, there is a greater variety of zebras in urban areas, but the concentration of them is very low or they are referred to these hospitals. Am I correct in assuming this?

Pretty much. You'll see less zebras in the city, but a greater variety within them. This variety means you're less likely to catch them because you don't see them nearly as often and they're more likely to catch you off guard, as compared to the rural zebras which are greater in number and lesser in variety, leading to them being more predictable than surprising, but interesting nonetheless.

 

[mats7]

You'll likely be private practice or a small group instead of being an employee of a hospital. Prepare for autonomy and paperwork!

 

[jordansetron]

Thanks for such comprehensive replies!

 

[cabinbuilder]

I think the one thing I would be worried about is dealing with less diversity of cases. I don't think that is too much of an issue in towns of 30,000 and above. However, worrisome for those below that number. If one wanted to practice in a bigger city after sometime, they may have a tougher time trying to deal with a "zebra." This is probably conjecture on my part.

Trust me there is no lack of case diversity in rural areas. People are sicker, poorer, and have less access to care. You see them when they can't physically go to work anymore, etc. Plenty of diverse cases because as the solo provider you see everyone. You may not see the "zebra" in the city since most go to specialists.

 

[cabinbuilder]

I also heard rumor that the more rural it gets, the bigger your salary cheque (I knew a Canadian FM physician who works waaaay up north, and he makes 300k per 6 months or something like that) . Anyone wanna clarify on this?

All comes down to the quality of the contract.

Where I work locums in Wyoming they can't get a permanent doctor because it's a flat salary without RVU or bonus incentives. The same job I just took in Texas has a base pay that is 80K higher with 2 different bonus plans that can double your salary if you code properly.

 

[costales]

Every rural doc I know is very happy with their income and lifestyle.

 

[ortnakas]

The other thing to consider is cost of living. Even if salaries are comparable, you'll spend less living somewhere rural than a big city.

The same is true with Midwest/South/"flyover" cities versus "cool" ones. You can rent a house somewhere like Cleveland, Boise or Omaha for the cost of a tiny apartment in San Francisco, Seattle or NYC. (cities picked somewhat at random for example)

 

[Goro]

And you can buy a house where in some cities, it's nearly impossible.

And speaking of rural medicine, did you guys see this?

http://msdh.ms.gov/msdhsite/_static/23,5975,341,517.html
http://www.wdam.com/story/28602963/world-tuberculosis-day-disease-still-very-active-in-mississippi

The other thing to consider is cost of living. Even if salaries are comparable, you'll spend less living somewhere rural than a big city.

The same is true with Midwest/South/"flyover" cities versus "cool" ones. You can rent a house somewhere like Cleveland, Boise or Omaha for the cost of a tiny apartment in San Francisco, Seattle or NYC. (cities picked somewhat at random for example)

 

[JustPlainBill]

I initially thought I wanted to be a rural doc and worked as an employed physician at a critical access hospital -- problem was that everyone with insurance went to the next county over with a full service hospital and specialists, what was left was the true poor and medicare/Medicaid who couldn't afford to go anywhere else -- and those had been patient's of the 6 physicians in county for years -- the person that recruited me, whom I trusted, stated that I would get their overflow, there was plenty of work, etc. --- well, no overflow unless they were going out of town, no real clinic work/patients (had 25 on my panel after 8 months) -- what was really going on was that the other physicians wanted someone to cover their hospital call and the hospital itself was nothing more than an obs/short stay unit for all of the nursing homes -- for me, it was utter BS and I no longer have a relationship with the person who recruited me who had been a good friend ---

If you like rural living, it's ok but for me -- nope, I like my suburban practice and there's no way in hell you'd get me to go rural after that experience --

 

[IslandStyle808]

The other thing to consider is cost of living. Even if salaries are comparable, you'll spend less living somewhere rural than a big city.

The same is true with Midwest/South/"flyover" cities versus "cool" ones. You can rent a house somewhere like Cleveland, Boise or Omaha for the cost of a tiny apartment in San Francisco, Seattle or NYC. (cities picked somewhat at random for example)

One of the rare exceptions is Hawaii. Living in almost any city in California, Washington, or New York (except the big cities of NY) is cheaper than any rural area in Hawaii.

 

[Dr Tony T. Chopper]

So...go rural, pay off loans and buy up property left and right, then retire with a massive real estate empire under your name?

 

[NurWollen]

So...go rural, pay off loans and buy up property left and right, then retire with a massive real estate empire under your name?

Of course. Build a real estate empire then run for POTUS.

 

[jtm0021]

And you can buy a house where in some cities, it's nearly impossible.

And speaking of rural medicine, did you guys see this?

http://msdh.ms.gov/msdhsite/_static/23,5975,341,517.html
http://www.wdam.com/story/28602963/world-tuberculosis-day-disease-still-very-active-in-mississippi

Speaking of TB...

http://www.alabamanews.net/2016/01/18/47-cases-of-tuberculosis-confirmed-in-perry-county/

 

[Goro]

That's the county I was thinking of! One state over.

Speaking of TB...

http://www.alabamanews.net/2016/01/18/47-cases-of-tuberculosis-confirmed-in-perry-county/

 

[jtm0021]

That's the county I was thinking of! One state over.

Alabama, Mississippi...Doesn't matter we are either 49th or 50th in everything anyways.

I work at a heme/onc clinic in Birmingham, which is pretty far from Perry County, and we had two patients from there in clinic the other day. For heme/onc reasons obviously. So far so good though.

Oh and just to add something more relevant to the thread! I shadowed a FM doc (in a very rural county of AL) in a town of about 1,500. He told me that the county gave him and his partners 70K to help get their clinic up and running. I know that isn't that much, but something to consider.

 

[Dr. Death]

Alabama, Mississippi...Doesn't matter we are either 49th or 50th in everything anyways.

I work at a heme/onc clinic in Birmingham, which is pretty far from Perry County, and we had two patients from there in clinic the other day. For heme/onc reasons obviously. So far so good though.

Oh and just to add something more relevant to the thread! I shadowed a FM doc (in a very rural county of AL) in a town of about 1,500. He told me that the county gave him and his partners 70K to help get their clinic up and running. I know that isn't that much, but something to consider.

At least you have football going for you

 

[jtm0021]

At least you have football going for you

Kinda....I went to the other state school. We have had a fair amount of success though. And looks like we might have a former QB win a Super Bowl soon.

 

[DO2015CA]

BOOO Auburn.. jk

"Alabama... at least we aint Mississippi" is a common saying I have heard since moving down here

Kinda....I went to the other state school. We have had a fair amount of success though. And looks like we might have a former QB win a Super Bowl soon.

 

[jtm0021]

BOOO Auburn.. jk

"Alabama... at least we aint Mississippi" is a common saying I have heard since moving down here

Yup, I must say I love Alabama though. I am strongly considering returning after I'm done training. I don't mind Huntsville or Birmingham.

Are you at ACOM or VCOM?

 

[DO2015CA]

ACOM

 

[68PGunner]

Some people in my class have been talking about practicing in a rural area once they get picked up by a medical group. Other people have the idea that practicing in a rural area is the worst thing that could ever happen to a physician. The argument from the pro-rural doctors is that they would make more money and their money would go farther, allowing them to pay off their loans and establish some wealth early. If they really dont like it they feel as though they can simply move somewhere else once their contract runs out.

What are some of your thoughts on the pros and cons? Is it true that rural physicians working for a medical group are compensated more (fields like EM, IM, etc) than "urban" physicians? What is considered "rural" anyway? What is the marginal increase in compensation? Is it relatively easy for a physician to just pack up and move to another hospital?

It depends on how rural it is. For me, my limit is 1-1.5 hr drive to a major metropolitan area.

 

[Catfish-Cupcake]

The other thing to consider is cost of living. Even if salaries are comparable, you'll spend less living somewhere rural than a big city.

The same is true with Midwest/South/"flyover" cities versus "cool" ones. You can rent a house somewhere like Cleveland, Boise or Omaha for the cost of a tiny apartment in San Francisco, Seattle or NYC. (cities picked somewhat at random for example)

I live in one of those cities you mentioned. Everywhere I interviewed I was appalled at how expensive it would be to rent. Turns out where I live is just extremely cheap. Easy to find a place for $350/month with one roommate where I am.

 

[DO2015CA]

I live in one of those cities you mentioned. Everywhere I interviewed I was appalled at how expensive it would be to rent. Turns out where I live is just extremely cheap. Easy to find a place for $350/month with one roommate where I am.

That's funny because coming from California to Alabama I am the exact opposite. I feel like I'm living comfortably and it's still hundreds less a month than back home

 

[IslandStyle808]

Anything 1Bd/1Br for less than a $1000 is cheap to me, that is how expensive my state is even in rural areas.

 

[jtm0021]

That's funny because coming from California to Alabama I am the exact opposite. I feel like I'm living comfortably and it's still hundreds less a month than back home

Yeah I'm from Dothan and the nicest apartment complex there is only like 700 a month for a one bedroom. It is almost twice that in suburban Atlanta where I'm moving too for something comparable.

 

[jordansetron]

I'd rather live large in the country than be a sardine in the city. But then again most of my free time is spent playing fallout 4 so I'm pretty easy to please.

 

[jtm0021]

I'd rather live large in the country than be a sardine in the city. But then again most of my free time is spent playing fallout 4 so I'm pretty easy to please.

lol I haven't played in about a week, but I have about 2 days of playtime. Whoops.

 

[jordansetron]

lol I haven't played in about a week, but I have about 2 days of playtime. Whoops.

But General...another settlement needs your help

 

[EmergDoc2B]

And you can buy a house where in some cities, it's nearly impossible.

And speaking of rural medicine, did you guys see this?

http://msdh.ms.gov/msdhsite/_static/23,5975,341,517.html
http://www.wdam.com/story/28602963/world-tuberculosis-day-disease-still-very-active-in-mississippi

Another case of the effectiveness of a program being its demise.