homeless/low-income population vs. rural

[indigoblue]

which type of medicine is more needed in the US?

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[Trekkie963]

um...generally speaking, rural populations ARE underserved. Hence the need for doctors in rural areas...

 

[jlee9531]

not to nickpick but lots of rural areas are also low income areas...

but this all depends on geographics as well. some schools emphasize their rural programs cause that is around them more...ie uvm and msu to name a couple...

other schools emphasize the need to help the underserved urban areas...ie...usc, drew to name a couple...

both areas are in need and one should not be neglected for the other.

 

[indigoblue]

yeah, i realized that the subject was comparing the same thing so reworded it....

would you rather practice medicine in underserved urban or rural areas?

 

[jlee9531]

prolly the underserved urban areas since that is what i am more familiar with.

 

[indigoblue]

ok... what i was really trying to get at was whether or not there is a specific medical field for low-income/homeless urban population...

i'm not too familiar with the drew/ucla program... but don't almost all emergency rooms see low-income or homeless patients that are low-income? or do urban hospitals generally refer low-income/homeless to certain hospitals such as drew in los angeles?

 

[jlee9531]

generally speaking...if the school you are going to has a hospital that you can do rotations at is located in a low income area, then you will see a lot more of those types of patients, but if you are in a nice suburban area, i doubt that you will see many low income patients that need care since they will prolly go to the hospital that is closest to them.

there is no specific medical field that you need to enter to help the underserved, but there are unique programs like the ucla/drew program that accepts students that have a passion for serving in these areas and accepts them and allows them to work in the hospitals that serve these patients...ie king/drew.

there are many hospitals known for being able to see a wide variety of things during rotations, and these hospitals are more likely to be found in bigger urban areas. you have county as usc, and grady at emory and the philly hospitals and the nyc hospitals etc...a good number nationwide.

 

[indigoblue]

so there is such a thing as practicing strictly inner city medicine... i guess my perception of practicing medicine in urban areas was that doctors would see both high income and low income people

 

[jlee9531]

Originally posted by indigoblue
so there is such a thing as a specialty in urban slums? what would be the more euphemistic term for it?

no there isnt.
outside of rural programs that a few of the schools have....
there is no specialty when it comes to dealing with low income areas. you just go there and help. thats about it.

 

[LoneCoyote]

Originally posted by indigoblue
so there is such a thing as practicing strictly inner city medicine... i guess my perception of practicing medicine in urban areas was that doctors would see both high income and low income people

You can get a job in a city at a clinic for homeless or low income people. Then you would spend your whole day seeing underserved patients and rarely would see income people. San Francisco is known for its public health system which includes this type of practice setting. So I guess one could argue that these docs practice "inner city" medicine, even though as jlee pointed out it is not a specialty per se. Probably family practice, internal medicine, preventive medicine, or peds is the way to go to practice i this type of setting. I personally would rather practice in an underserved urban area because I'd rather live in a city and I am familiar with working with this type of population already.

 

[rgbcolumbia]

http://nhsc.bhpr.hrsa.gov/

 

[Kalel]

Both rural and inner-city populations are underserved. Both regions tend to have poorer patients, many of whom do not have health insurance, which means little or no physician reimbursement for their care by the state and federal government (when people without health insurance and are admitted to a hospital, the physician on call for that hospital is required to see him or her, and the state only partially reimburses the hospital for it's losses but doesn't pay the physician anything for his or her time or malpractice risk. When they are insured with medicaid, medicaid pays dirt low reimbursement rates, oftentimes below the cost of running your office or doing a procedure for that one patient). Congress recently passed a medicare bill that should increase medicare payments to physicians over the next 10 yrs to help offset these differences, but rural areas also face the challenge of being an undesirable place for physicians to live. The public education system is oftentimes poor, and it's a very different type of culture out in some rural areas that a lot of physicians just are not comfortable living in. It's very easy for a physician to commute to a city, but a lot of physicians choose not to work in cities because of the medicaid/no health insurance problem again, plus a lot of these patients have very challenging social issues that make them non-compliant and oftentimes complicates their care.

 

[uclacrewdude]

Originally posted by jlee9531
no there isnt.
outside of rural programs that a few of the schools have....
there is no specialty when it comes to dealing with low income areas. you just go there and help. thats about it.

yeah ... im gonna have to ... go ahead and ... sorta ... disagree with you on that ...

one of the major pitfalls of the current medical system is that it makes people without adequate insurance delay medical care until it becomes an emergency. hence the er becomes point of entry for a lot of underserved populations, one more thing pulling me in the EM direction.

ckent is right in that the suburban draw pulls docs away from both urban and rural areas. think about it this way -- is there a glut of doctors in cali or in kansas? cali, b/c like everyone lives in the suburbs, whereas kansas is basically one big farm.

 

[Goguryo]

so there is such a thing as practicing inner city medicine...my perception of practicing medicine in urban areas was that doctors would see both high income and low income people

you see, what happened was i assumed the army was for homeless and low income people (or the very well connected), and that's why i went to the amedd scholarship people and usuhs, and then i was discharged and then i went back to cpol to get the job and that's why i talk to SDN

 

[riceman04]

ok... what i was really trying to get at was whether or not there is a specific medical field for low-income/homeless urban population...

i'm not too familiar with the drew/ucla program... but don't almost all emergency rooms see low-income or homeless patients that are low-income? or do urban hospitals generally refer low-income/homeless to certain hospitals such as drew in los angeles?

yes there are specific hospitals where typical medicaid and homeless patients are taken.
However, you sometimes do have that middle level hospital (like Herman Hospital in Houston) who will accept such patients in addition to their higher paying patients.

Guess how they are able to afford to take these patients in? They use a cost-shifting method...i.e. people with great coverage (whether it is through private insurance or private funds) will be charged more for "the same" care.

No worries I am definitely not whining...just trying to explain the facts.

Poor patients will never (very rarely) be sent to a hospital like Cedar-Sinai

 

[DropkickMurphy]

Underserved rural areas so that I don't have to worry about getting mugged walking to my car after my shift in the ED. But the real deciding factor will be finding a happy balance between low cost of living, decent area, and high pay.

 

[mcat_study]

which type of medicine is more needed in the US?

def. rural needs more docs.

urban--has too many docs already, take nyc for example.

 

[CptCrunch]

def. rural needs more docs.

urban--has too many docs already, take nyc for example.

Sure there are more docs in urban areas, but low-income families still have piss-poor access.

 

[Vox Animo]

This thread is over two years old, who bumps these things?

 

[TMP-SMX]

This thread is over two years old, who bumps these things?

You beat me to it...

 

[mcat_study]

Sure there are more docs in urban areas, but low-income families still have piss-poor access.

well lets see, bellevue in nyc (spell wrong?) handles many emergency cases, and treats many many many homeless people if they need help. doctors are pretty good also--NYU people.

we are actually talking about different "access" problems--in rural areas it is literal, physically not enough doctors/hospitals, in urban-- it is more of financial kind of access problem. although there are poor people in rural areas as well who can;t afford medical care, but that is a lesser problem than the aforementioned one.

 

[thedelicatessen]

Both types of environments need doctors, but I think the low-income/homeless gets more publicity. It seems more dramatic for someone to want to work in the trenches of poverty, but rural medicine is a different kind of challenge. As for living environment, the doctor for the urban, homeless area can still live in a ritzy part of an urban area and can relay patients to large hospitals, but the rural doc is usually limited to living in a small area with oftentimes limited medical resources. I guess it's just preference as to which is better or whatever.

 

[Law2Doc]

This thread is over two years old, who bumps these things?

That same guy seems to be bumping up at lot of old threads. I don't get it -- I wish he at least would acknowledge that it's an old thread when he does this so the rest of us don't get confused.

But at least it's fair to say that issues of the underserved haven't improved much since back then.

 

[clsr2nrvna]

WVU have the best rural med program in the US, IMO. But ex$pen$ive! Kinda ironic...