Life in the country

[sophiejane]

So, I am really excited about rural medicine. Both my husband and I have big plans for our life in the country and we can't wait to get out of the city.

We have wonderful friends in the city, however, and we enjoy going out on the town occasionally, so we plan to be close enough so we can get into the city for our urban fix once a month or so. But, we still want to be an active part of our community and blend in as well as we can.

My question is for those of you who have grown up in small towns. I know how closely knit small communities are--having spent several months of my rotations in one. I've heard that it's hard to break into that closeness if you are new in town, however. Have you found that to be true?

Also, we are pretty left of center politically...though we certainly aren't activisits--i.e., bumpersticker/tshirt/yard-sign types. We have both travelled a lot and are way overeducated, and I guess we like to think we are pretty worldly and open minded people. I know that small towns, particularly in the south/southwest tend to be pretty conservative, but we do get along with lots of different types of people (as evidenced by the parties we throw for our friends, where no one knows each other!).

Is there any hope for us to find friends and like-minded people in a small community?

By small, I mean 6-7K, 1-2 hours from the nearest large or medium sized city.

And what about schools....? Are they as bad as people say?? We don't have children yet, but want to soon...

Sorry for the ramble. Looking forward to your replies...

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[Jack Daniel]

Sophiejane:
Of the concerns you mentioned, I think your biggest will be schools. I grew up in a very small town and am (as an adult) very critical of my education I received (as a child)--but really enjoyed my childhood and my teen years. I loved country life in every way, and think that in the end--the scale still tips towards living in the country, but I'm very concerned about finding strong schools in rural areas. Now I've lived in both large and small cities. My daughter has been in schools in Boston and a much smaller town in the Southeast. Her educational experiences in Boston have been far superior.

I'm very interested in practicing rural medicine, and have searched out docs who have practiced in rural areas in order to ask questions about their experiences. Education seems to be a common concern. One doc I spoke with worked in Montana. He eventually sent his son to a boarding school hundreds of miles away. (As for his career, though, his medical experiences were AWESOME!).

Like I said, if I had the opportunity, I would still probably want to go rural. However, I would plan on being very active in providing opportunities for my kids in any areas I perceived the system being deficient.

As for the other stuff, I wouldn't worry about it. I've found that folks in the country are often lacking in sophistication, but are sharp as tacks--and they have little patience for big-city snobbery. Treat people as equals and you'll have all your parties filled--regardless of your political and social philosophies. By-the-way, you seem like someone I'd love to have as a neighbor.

~Boston

 

[MossPoh]

I am still an undergrad student but grew up in a relativley small midwest town. The county was large (takes about an hour if you drive the speed limit to get acrosse) and had a population of rougly 40 to 50K...10k or so was a small junior college which caused a big spike during regular semester times. Growing up I was very critical of it. As a kid though I think it is your job to dislike where you are from...or love it with a passion but neither of which involve seeing it for what it is. We moved into the town from south florida when I was about 4 and honestly didn't have trouble breaking in at all. My dad is a quite to himself guy that is a radiologist and my mom is the outgoing type. We found ourselves very active within the community early on...my mom was even on schoolboard for a while. I'd have to say the only major downfall for me was my education. I essentially breezed threw the entire 12 grades without opening a book, got to a major university and almost failed out from lack of study habits and the fact they actually expected more of me. In hindsight I don't regret living there. My parents were slightly left as well which never really caused too much problems besides the occasional anti-semitic joke since my father is jewish. I now aim to find a town of the same size once my long road of schooling comes to an end. While I like the culture and events in a bigger city, the pacing just isn't for me. I was raised with a nice international view by travelling to lots of places, going to art museums, seeing plays, and everything else. Your perception of country people is generally right. People treat them like they are idiots but it is just a whole type of intelligence. I don't know many people that have harvested corn or picked watermelons before.lol I think too much emphasis is placed on practicing in big cities and don't realize that an hour or two drive really isn't that bad to go see a professional sports game or hit up a museum once a month. When you are in the city you are always surrounded by reminders. In the country, after a hard days work you can sit out with friends on a nice plot of land or by a lake and fish a bit while grilling and having beers. Anyway..that was my tangent. good luck with whatever you choose!

 

[Antiviral22]

I am also thinking about country life as a family physician (currently an MS1). Let me put a twist on things by asking this ...

Does anyone have any experience with (personal or friends) home schooling? Let's say one of the two parents (or significant other) has the ability to home school a child, is this a wise choice? I am sure there are many questions about social skill development, diversity of activities etc etc. What are peoples' thoughts on home schooling??

 

[flighterdoc]

I'm from a very big city (Los Angeles) and while I'm still in med school, I own property and have lived for a time in a very rural part of Idaho (I'm quite the non-trad student), so I have some experience with moving in and getting along.

First of all, remember that you are moving into THEIR town and lives. You need to adapt to the local culture, and nobody cares too much about how it was done in the big city, or what brands you can buy in the big city grocery store. If you ask a storekeeper (politely) to order something special for you, they most likely will, once...after that, you better buy it.

If most of the town wears jeans and boots, and drives pickup trucks, a BMW Z-3 is probably going to be problematic - especially in getting it fixed.

Small towns are notorious for gossip. As a physician, of course, you can't violate patient confidentiality. Even though most of the town will know about your patients condition(s) as well as you do, don't get sucked into it...and don't gossip about anyone, ever, about anything. NEVER complain about anyone in town, your patient might be their uncle (or brother). Family ties and clan associations (for want of a better term) run strong and deep, and may be completely hidden from outsiders like you.

The two biggest areas for disagreement are going to be religion, and politics. If yours don't match theirs, don't discuss them, PERIOD. Smile and say something noncommittal, and move on. Small towns may have 20 different churches (I've seen towns with less than a thousand people with that many different churches, all filled on sunday) but there's usually only two flavors of religion, ours and theirs....and most people like it that way.

Support the local economy as much as you can. Hire local people when possible, buy at local stores when able. In Idaho, Montana and Wyoming it's not at all uncommon for people to make a day of Saturday (or Sunday) to drive to Washington (from Idaho) or perhaps Montana (from Wyoming) to buy in states that don't charge sales tax, but be sure to buy some things from local stores, too. If you go to (say) a hardware store and ask for advice, you'll get it...but you better buy the materials for the job there, if you go to Home Depot next weekend and buy them there, the locals will either not help you (if you're lucky) or give you very bad advice and watch you fail (if you really upset them).

Basically, if you want to get along, go along with the local customs and courtesies.

 

[MossPoh]

I am also thinking about country life as a family physician (currently an MS1). Let me put a twist on things by asking this ...

Does anyone have any experience with (personal or friends) home schooling? Let's say one of the two parents (or significant other) has the ability to home school a child, is this a wise choice? I am sure there are many questions about social skill development, diversity of activities etc etc. What are peoples' thoughts on home schooling??

Um. From what I noticed (I dated a girl that was homeschooled and a few other people I knew tried it) it was generally kind of sketchy. A few of them entered our high school after a certain point and really did miserable in that it was just overload for them. I don't frown upon home schooling but teaching is a very dynamic area where one needs more than a textbook to be successful. There is a reason they don't hire too many teachers that teach chemistry, geography, and english or something...hard to master that much different knowledge. The ones that were most successful had a small team of kids and it was almost like a mini school in itself. The girl I dated was very good at literature based stuff and VERY VERY good with anything pertaining to religion since her dad was a pastor but she fell very short in the other areas and failed the first level of chemistry and almost bombed out of geometry. It is possible and I have seen some very well educated homeschooled people in small towns but most of the ones that still had a chance to move away and go to a major university tried, had panic attacks, and went within reach of their parents. I am not judging whether this is good or bad..it is just what happened. One thing that a group worked out was to send their kids for specific classes at the local school and then pick them up and continue with the other stuff at home. Or as I saw on t.v. the other day they have the possibility to do the videoconferencing technology stuff and link different areas. I haven't done a search but I'd assume that is at least developing if it doesn't exist already...Might be worth a try to look into that.

 

[RuralMedicine]

So, I am really excited about rural medicine. Both my husband and I have big plans for our life in the country and we can't wait to get out of the city.

We have wonderful friends in the city, however, and we enjoy going out on the town occasionally, so we plan to be close enough so we can get into the city for our urban fix once a month or so. But, we still want to be an active part of our community and blend in as well as we can.

My question is for those of you who have grown up in small towns. I know how closely knit small communities are--having spent several months of my rotations in one. I've heard that it's hard to break into that closeness if you are new in town, however. Have you found that to be true?

Also, we are pretty left of center politically...though we certainly aren't activisits--i.e., bumpersticker/tshirt/yard-sign types. We have both travelled a lot and are way overeducated, and I guess we like to think we are pretty worldly and open minded people. I know that small towns, particularly in the south/southwest tend to be pretty conservative, but we do get along with lots of different types of people (as evidenced by the parties we throw for our friends, where no one knows each other!).

Is there any hope for us to find friends and like-minded people in a small community?

By small, I mean 6-7K, 1-2 hours from the nearest large or medium sized city.

And what about schools....? Are they as bad as people say?? We don't have children yet, but want to soon...

Sorry for the ramble. Looking forward to your replies...

I grew up in a small rural community (although not where I practice now) so perhaps that has shaped some of my perspectives. Now I practice in a community of about 4,000 (our county which consists of a lot of unincorporated rural areas is about 30,000). I think I have been more than accepted by the community and it is the community that convinces me to stay in spite of many other deterrents.

As far as the education situation I think you can always work with what you have for your kids and work to encourage the community to provide more. I graduated from a 7-12 high school with less than 600 students and still managed to pursue my educational and career goals. My parents considered private school but ultimately opted to work to improve the school system in our community.

 

[raptor5]

And what about schools....? Are they as bad as people say?? We don't have children yet, but want to soon...

I grew up in a small town. So small we didn't have a name, so we used the zip code from like 3 towns over. Anyway about the schools. I assume you are looking to stay in the Midwest where every small town has an ISD or the like. They are for the most part underfunded b/c of their small population thus low revenue base. Underfunded shouldn't mean undereducated or underqualified. The best way to ensure that your children obtain a quality education is to not think of school as a place they go for most of the day that spits out an educated young adult 13 years later. I firmly believe that an involved parent that is willing to help their child and facilitate their learning (ie summer programs) will be happy with the end result. I suggest go to school board meetings or even try to get on the board, if you can. Go to PTA meetings. Volunteer your services as physician to the school to cover physicals, athletic events, etc. These things will help you gain the respect and trust of the locals allowing you to voice your ideas or concerns without being dismissed as the city slicker who is trying to change the way they live.
What these small districts lack in educational opportunities they make up for in values. As long as a parent is willing to bridge the gap in education any child can be successful.

 

[mustangsally65]

One of the things that I find so appealing about small, rural towns is that (in the south at least, where I'm from) the residents are usually the friendliest people you will ever meet. They're genuine, honest, and simple (in a good way). There will always be people who don't like strangers or outsiders, but the majority of people are welcoming and open and friendly.

I live in a town of about 1000 permanent residents. But the town's main industry is tourism, so that puts a spin on how the residents view outsiders (many of whom spend 7-8 months out of the year there as part-time residents). If you're worried about fitting in, find a town that relies heavily on tourism (but not in a bad way: I live in the mountains in a national forest and people come to get away from the city, to see waterfalls, to go hiking etc.) and you'll be accepted.

Right now I'm in Durham (doing a program in Chapel Hill for the summer) and I'm soooo homesick. It's so different from what I'm used to, and I can't wait to get back to rural Appalachia. How can you guys live in such a big, crowded place?

 

[sophiejane]

Thanks for the replies, everyone. I'm reassured knowing that your advice about fitting in is pretty much what I think my instincts would be, anyway. We aren't flashy AT ALL (Jeep Wrangler and 2003 Corolla), nor are we slick in any sense of the word. We're pretty down to earth people, and I think we'll do just fine.

Good to hear your takes on the school situation. We've considered home schooling until high school...but I think I agree with Raptor that you have to be involved in school to be involved in the community. Seems like small towns are all about school and church. We can do the school thing, but church is another story...

Should be interesting!

 

[mustangsally65]

I went through a rural public school system and I turned out okay. I think it's better to go to school in a small place because you get more attention from the teachers, which is good in any situation. If you're struggling they help you catch up, or if you are way ahead of everybody else they give you extra projects to keep you busy and happy.

Many people think kids in rural areas miss out on a big social life growing up, but I don't think that's true either. I think I have a better moral/value system than others my age who grew up in a big city, and I know I care more about people because I was around the kind of people I described in my previous post. There aren't that many shady people in smaller towns: everyone just does their own thing and isn't out to get anyone (at least in my experience). I know that sounds like I'm accusing bigger-city people of being horrible, but that's not my intention either. I think your parents play the biggest role in what kind of kid you turn out to be.

I'm from the south and I live in a major Bible-belt town. I never went to church and it wasn't ever really a problem. The Baptists tend to be the most fanatic about it, while Methodists and Presbyterians and other (sects? I don't even know the right word to use here!) kinds arent' quite as zealous. The main thing I would warn you about is using words like "G-D" around strangers at first. A lot of people where I'm from will use every kind of profanity under the sun, but if you "take the Lord's name in vain" you are most certainly going to Hell. Don't use "God" in anything, like "Oh my God," things like that, until you get a feel for the people around you. Pay attention to what the locals say and then go from there. I have met some extremely religous people who use phrases like "G-D" and treat it like what it is: a completely unrelated phrase that really has nothing at all to do with God now in the 21st century.

It can be quite funny at times. PM me if you have any specific questions.

 

[sophiejane]

The main thing I would warn you about is using words like "G-D" around strangers at first. A lot of people where I'm from will use every kind of profanity under the sun, but if you "take the Lord's name in vain" you are most certainly going to Hell. Don't use "God" in anything, like "Oh my God," things like that, until you get a feel for the people around you. Pay attention to what the locals say and then go from there. I have met some extremely religous people who use phrases like "G-D" and treat it like what it is: a completely unrelated phrase that really has nothing at all to do with God now in the 21st century.

That is so funny--my dad is exactly the same way. He will cuss like a sailor but you say God-anything around him outside of saying grace or church and he gets extremely offended. So I am already socialized to that little quirk!

 

[neutropenic]

My clinic secertary's sister lives here

Shamong

and they seem to like it quite a bit, township with about 6000 people, about 1 1/2 hours drive to Philly but very forested and rural with a good school district (Lenape School District) which is consolidated with nearby more suburban towns so it is country living with competitive schools. About 45 minutes drive to the beach.

 

[mysophobe]

The Lenape School District is okay depending on the school. It might have changed, but the school I attended wasn't the greatest to say the least.

 

[Dancing Doctor]

So, I am really excited about rural medicine. Both my husband and I have big plans for our life in the country and we can't wait to get out of the city.

My question is for those of you who have grown up in small towns. I know how closely knit small communities are--having spent several months of my rotations in one. I've heard that it's hard to break into that closeness if you are new in town, however. Have you found that to be true?

Also, we are pretty left of center politically...though we certainly aren't activisits--i.e., bumpersticker/tshirt/yard-sign types. We have both travelled a lot and are way overeducated, and I guess we like to think we are pretty worldly and open minded people.

Is there any hope for us to find friends and like-minded people in a small community?

By small, I mean 6-7K, 1-2 hours from the nearest large or medium sized city.

And what about schools....? Are they as bad as people say?? We don't have children yet, but want to soon...

Sorry for the ramble. Looking forward to your replies...

Let's see, I grew up in ohio, a town less than 5K in people (most of whom I was related to, ) Anyway, in my area it is very difficult to infiltrate. They have their own ways of doing things, and generally one doc who sees everyone. If you don't have an "in" (i.e. someone to vouch that you know what is going on) it will be hard. However, once accepted you're in for life.

If you don't bring up your politics with your patients, I doubt it will be a problem. My family thinks I am nuts, I am a libral and it is way beyond their comprehension. But it sounds to me like you can get along with most people and this generally shouldn't be a problem.

As far as education goes, it truely depends on the people who are educating your child. I totally disagree with home schooling, and I am not convinced we should even allow it. But that's a personal view after having relatives/friends who did it, and did it poorly. Public school in my area was decent in the sciences, but English skills were barely taught at all. I simply did summer classes for gifted/talented students, read on my own, etc. My parents helped some, but they too graduated from the same school district I was in, and so their experiences were not a whole lot better than mine.

My town is full of churches and bars, but if you don't frequent either one people don't notice much. Just be aware that people are watching you all the time, they will tell everyone what they see you doing. It's like being in a glass box. People know what is happening in your life. Even if your far away. My example: I was 6 hours from home at college. I fell ill and was in the hospital. Within 7 hours of my admittance through the ER, I had 7 phone calls from people in my town who wanted to see how I was, wish me well, or tell me they were praying for me.

I, too, am excited about the prospect of rural medicine, and I cannot WAIT to get out of the city. The noise and the traffic are almost unbearable. But I have 4 years before that's even a thought.

 

[mustangsally65]

Living in a glass box is annoying at times, but most of the time I have found that it keeps you honest and humble.

I mean, you can't tell lies because the whole town knows what's going on in your life, so it kind of forces you to face the truth sometimes.

My town has tons of churches but no bars (dry county, no alcohol in restuarants etc.) so it's kind of worse because the religious people look down on anyone who drinks. I used to work in a gas station and saw tons of people sneaking in to buy their beer (funny, because you could sell alcohol and wine, but couldn't drink it on the street, in a restaurant etc.) and hurrying to pay to get out before they were seen.

 

[Dancing Doctor]

Living in a glass box is annoying at times, but most of the time I have found that it keeps you honest and humble.

I mean, you can't tell lies because the whole town knows what's going on in your life, so it kind of forces you to face the truth sometimes.

My town has tons of churches but no bars (dry county, no alcohol in restuarants etc.) so it's kind of worse because the religious people look down on anyone who drinks. I used to work in a gas station and saw tons of people sneaking in to buy their beer (funny, because you could sell alcohol and wine, but couldn't drink it on the street, in a restaurant etc.) and hurrying to pay to get out before they were seen.

I don't think the people in my town would get on too well if there were no bars. It's great people my age (23) can hang out and drink AND get hit on by people who are the same age as our parents or older. Where else do you get that kind of family atmosphere?

On a slightly more serious note, your town sound like the town in Footloose. Please tell me dancing is allowed.

 

[MiesVanDerMom]

hmm, some of these posts sound like some kind of anthrogological study. i'm rural myself. i agree with the above posts indicating that the people in my rural area anyway are more welcoming to "outsiders" than the city people i've lived with (new york city, pittsburgh, etc.) the schools were fine. i mean, i've seen how the schools are in rich-a$$ suburbia. and no, our schools aren't like that. but, frankly, I don't want my kids going to schools like that anyway. i'd much rather they have time to themselves to read what they choose. there's no reason high schoolers should have 4 hours of homework a night. just brainwashes them. i think homeschooling is always a good option. anyone learns best when they're choosing the direction/the material. pennsylvania now has a public cyber charter school so you can sort of homeschool via an internet school.

as for politics. the thing about rural folks is that we have a certain independence urban/suburban types don't. i think it's inaccurate to say "conservative". i think it's more about wanting to be left alone by the government etc. more libertarian/anarchist really. but every town has its liberals. unfortunately.

 

[ligroce]

Sophiejane
I know the perfect place for you to live. Check out this website and see for yourself.
P.S. And you can be my neighbor.

Link deleted. Solicitation is a violation of SDN TOS.

 

[Dancing Doctor]

here's the website for the rural town i grew up in. they put it together all by themselves, haha!

http://www.eastpalestineohio.org/

 

[sophiejane]

here's the website for the rural town i grew up in. they put it together all by themselves, haha!

http://www.eastpalestineohio.org/

I might have to go visit just so I can see that new "state of the art waterslide" at the community pool.

 

[Dancing Doctor]

I might have to go visit just so I can see that new "state of the art waterslide" at the community pool.

Oh good grief! I worked at that pool from the time I was 16 until I was 20. My mom worked there when she was in high school. My sister works there now. I am actually in some of those photos (which were taken about 2001). "state of the art" for us means something that hasn't been there since the pool was build just after the war. on the positive side, you can go all day (noon-9PM) for $3/adult, $2/child.

Additionally: To the post on home schooling, in my area it's a BIG NO-NO. Most people are not intelligent enough to allow their children to learn what they would in school; however even if you are (and as doctors I am making that assumption) in my town you would be thought of as uppity (i.e. you're too good for our school system). I'd be careful if you decide it's for you.

 

[McDoctor]

here's the website for the rural town i grew up in. they put it together all by themselves, haha!

http://www.eastpalestineohio.org/

http://www.kanezo.com/

This would be a great forum for posting the websites of our respective hometowns. The "rappin' granny" from The Wedding Singer was born in my hometown. I'm surprised they don't mention on this site.

 

[deucerp]

So I'm a newly minted MS-III on my surgery rotation. One of our attendings is always trying to get us to talk about what we want to do, especially if it's a surgical field. I've always felt like I wanted to be a small town family doc where I would have a few more liberties procedure wise and basically be able to take care of most of the problems in the community. He tells me that one, if you have money in the country and are sick you go to the nearest big town and get treatment. Two, no one has the money in the beginning to buy the equipment necessary to do things on site like EKG, CXR, scopes and whatnot. What do you guys think?

 

[sophiejane]

So I'm a newly minted MS-III on my surgery rotation. One of our attendings is always trying to get us to talk about what we want to do, especially if it's a surgical field. I've always felt like I wanted to be a small town family doc where I would have a few more liberties procedure wise and basically be able to take care of most of the problems in the community. He tells me that one, if you have money in the country and are sick you go to the nearest big town and get treatment. Two, no one has the money in the beginning to buy the equipment necessary to do things on site like EKG, CXR, scopes and whatnot. What do you guys think?

You should do an FM rotation in a smaller community with a well-appointed community hospital and you can see for yourself. True, really big stuff will get sent out, but you have to stabilize them first. Not to mention all the chronic people, etc. So he thinks NO ONE in small towns sees their local doc? That's interesting, because a lot of them are doing very well...

See my post on the FM board about reimbursements...http://forums.studentdoctor.net/showthread.php?t=296555

See other threads about repayment offers..there are grants available to set up practices in underserved areas--plus loans out the wazoo. If you want a colposcope and an EKG (fine things to start with IMO) you can get them...

If you really want him off your back, tell him you want to be a surgeon JUST LIKE HIM and you will be the pet of the rotation...

 

[sophiejane]

http://www.kanezo.com/

This would be a great forum for posting the websites of our respective hometowns. The "rappin' granny" from The Wedding Singer was born in my hometown. I'm surprised they don't mention on this site.

Okay, that's a pretty darn cute town.

I think you've raised the bar here.

Anyone else...?

 

[Dancing Doctor]

http://www.kanezo.com/

This would be a great forum for posting the websites of our respective hometowns. The "rappin' granny" from The Wedding Singer was born in my hometown. I'm surprised they don't mention on this site.

One of my best friends from College lived in Mt. Carmel... Small world!

 

[sophiejane]

Okay, this isn't really my hometown but it's where I did my FM rotation and all my rural track preceptorships...

http://www.pebbleridgeincuero.com/morecuero.html

AND it's the TurkeyFest capital of the WORLD...

http://www.cuero.org/

 

[raptor5]

Mt. Carmel. hmmm. Lived about 10 miles from there. The first cable company in the US, started in 1948, is not too far from there. There are also 2 towns nearby that used to have the highest number of bars per capita.

 

[beachpotato]

Homeschooling is all what you make of it. Some programs work well for one kind of learner, but not another. There are rigorous academic curricula and not-so-rigorous. There are lots of sites that give good advice as to what best fits your family. If you are leaning towards the rigorous, check out http://www.welltrainedmind.com/index.php. It will give you a good place to start, but keep in mind it is impossible to do absolutely everything in the book. Just take what is appropriate for your kids.

It *is* a little more difficult to do high school math/science/languages, though. There aren't as many curricula to choose from for science (though there are good ones out there) and living foreign languages (I don't think any existing curriculum can stand alone, but YMMV) and many parents are uncomfortable teaching math (probably wouldn't be a problem for someone who had to pass calculus already). At this stage, many parents prefer to have kids take community college classes (looks good on apps, too) or use tutors.

Of more concern is the availability of community resources. A good library is a must (unless you want to rely on Amazon) and a homeschool playgroup/cooperative and/or sports/enrichment classes. In urban areas, it's possible to overschedule HSers with all the extracurricular options, but in rural I would think not so much. You have to let them out of the basement sometime...

 

[deleted77919]

Two, no one has the money in the beginning to buy the equipment necessary to do things on site like EKG, CXR, scopes and whatnot.

EKG machines are not terribly expensive, totally doable. X-ray machines are pricey, you need to make sure you'll have the volume to cover the cost. Ultrasound can go either way, used machines aren't prohibitively expensive, but brand new portables are pretty pricey. Can't say I know much about how much scopes cost.

Loans are available, but if you are carrying a lot of debt from medical school, want to live in a house, want to build an office (suitable space in a small town might not be avilable for purchase or rent) then get things like exam tables, computers, an EMR, BP cuffs, chairs, a TV for the waiting room, waiting room furnishings, saltwater fish tank, art to hang on the walls, a car to replace the one that died at the end of residency, etc, etc . . . it all starts to really add up. Not an easy thing to do right from the outset.

 

[PeepshowJohnny]

With all apologies to John Mellencamp, I was born in a small town as well.

While my ambitions run pretty opposite of yours, I feel add a bit to small towns.

Education is going to be your biggest concern. High schools aren't actively bad, but many small towns have basically no programs for kids who are above average. My high school had some special education, and pretty much everyone took the same classes. No advanced placement, no college prep, none of that stuff. This lead to a problem where bright kids would breeze through coursework, think themselves a genius, go to a college and get stomped by kids who worked hard in high school. You are probably going to end up having above average kids, based on their genes and coming from a succesful household, so that's definitely a concern. Private schooling is sometimes available, usually in a slightly bigger neighbor town, most often a Catholic school in my area.

The next biggest problem is probably the privacy. This is the biggest factor of why I won't practice/live in a rural area. Everyone is going to know all of you and your families business. And you will be expected to know everyone elses. If that appeals to you, then it's great. If you're more private like me, it can be unnerving.

 

[deleted77919]

By small, I mean 6-7K, 1-2 hours from the nearest large or medium sized city.

For people interested in rural medicine who are not from sufficiently rural areas . . . how do you pick a place? Do you just say "Montana sounds cool!" or look through ads? How do you know if a place that size already has sufficient physician coverage?

I grew up in a relatively small place (city of about 90,000 but I was way out in the suburbs) and think rural family medicine could be interesting, but have no idea how one goes about deciding on a place to practice after residency.

 

[Doowai]

I currently live in a city of 7 mill, went to graduate and undergrad school in a city of 2 mill, but lived 7 years in a city of 3,000.

Many pros and cons. You will be a BIG fish in a small pond - you will be known and a minor celebrity whereever you go. If you are seen picking your nose EVERYONE will know about it THAT DAY. I owned a prominent business in that town - everyone knew me. My oldest son (now 16) was in kindergarten - a client named Marietta one day told me "I don't know if I should tell you but today your son had to stand with his nose to the wall on recess because he was spitting on the girls". I also got by with some things as a result - chief of police saw me run a red light, I simply waved and he waved back. My daughter was 4 or 5 and ran away on her tricycle, and we did not notice - a neighbor soon came walking back with the trike in hand and my daughter under their arm kicking and screaming, told me they found her about half a mile away. A friend from Maryland once sent a letter to my wife as a joke addressed "to the new [name of business] wife, [name of town] Missouri, and the zip code. No family name, no street address - just the words "wife" and my business - the letter was delivered promptly to our house - everyone knew where we lived etc.

People will come by while you are mowing your lawn to discuss their health with you. Everyone will ask you to sponsor their little league teams, and buy fund raising candy. You will get invited to patients birthday parties.

If people like you, they will excuse practically any fault. If you get one the wrong persons side (like Marietta who is just a little old rather financially poor lady, but extremely well liked and well connected by the entire town). In Republic Missouri a FP doctor was caught - he would prescribe narcotics to patients, make home visits and steal the drugs back and sold them on the black market - he was caught and sanctioned by the state board - but his license was not removed somehow miraculously, and he did not go to jail, and patients still went to him - why? they liked him. I was amazed by that.

WHen I first moved in I went through the town paper every week - which often had articles on things like who has the biggest tomatoes, or a guy who had used the same pitch fork to shovel manure for over 40 years (I am not making that up) - and found who had anniversaries coming up, or just joined the military, or made the B honor roll at the school etc - and hand wrote them a letter congratulating them etc. That paid off business wise for years.

Knowing that wherever I went someone knew who I was , and feeling like you are always "on" was hard for me sometimes. The schools were okay, but not alot of choices - where I am now my 9th grade daughter is taking college level math and biology at the public school - could not do that in many small towns I don't think.

There was no movie theatre in town. Very little to do. One time I heard a rumor that there was a guy who just bought a pink Ford 150 pick up that had a set of bull horns on the front. For something to do, my wife and I pushed the stroller with the kids down to see it.

So much more time in life. SO much more. Right now, in this city of 7 million, work is close - but that is still 20 minutes of driving. In the small town I could see my office from the house, walked to work in 5 minutes or so, and my sons school was literally right behind the office and I could open the back door of my office and watch him on the playground. I saved at least an hour just simply in driving time every day - and I used it. I wrote and published around 50 articles that were published. I got alot of time to just push the kids in a stroller. Pollution never burned my eyes, but many days we could smell the cows in fields a mile away.

If a business shuts down (as Little Tykes toys did one year) it puts alot of people out of business. Something always seems to take its place, but none the less - little towns are often very sensitive to little changes.

One big con for me was it was there was a significant amount of prejudice. I am white, but like other ethnicities alot. I tend to have good relationships with alot of Hispanics. The little town I was almost 100% white, and words like ****** were heard with nauseating frequency. In fact there was one black family in town, with a son that went to the local high school - other kids were greet him with "Hey ******" - no malice or hate in their voice, in fact they seemed to like him, but he was just known as "******". I had a secretary that had a half black son, and another secretary whose sister was married to a black guy - I confronted clients on more than one occassion about this, even though I knew that was not the best for business.

Religion was huge. A large number of clients asked about my religious beleifs.

THe worst part was incest. Its not the norm, but it was startingly present. On numerous occassions I had females tell me about an experience growing up, even though I had not enquired of it. Both of my daughters were born there, and I asked the OB about it - and they told me it was a real problem.

We moved there expecting Andy Griffith and Mayberry. In some ways it was that way. But the year we moved there it had the highest teen pregnancy rate in the nation (and we heard that on Paul Harvey while moving there), MTV did a show called SEX IN THE 90'S in which they compared New York teen sex activity with a nearby town (Monett Missouri) and Monett was found to be wwwaaaaayyyyy more promiscuous, Paul Stossell once did a documentary on the drug use (especially meth) on our small town, and there was one other show that Barbara Walters and Hugh Downs did on a very unfortunate incident that occured there. The point - in many ways it was Mayberry, in other ways it had huge problems with drugs, teen pregnancy, etc. Part of the reason for some of these problems were the fact there was NOTHING to do in the town - no movie theatre etc.

Overall it was a good place. I found alot of opportunity to serve the people - not always in business, but in many other ways. One time Marietta's son ran up a $500 credit card bill without her knowing it and it was very bad for her, she was rather poor. I anonymously sent her $500 cash in a priority mail envelope. She knew it was me and thanked me, but I denied it every day. At the time that was very little money to me. Another time the oldest daughter of a humble dairy farmer friend of mine got married, but could not afford a honeymoon. I paid for a weekend, all expenses paid and a luxury retreat for them. My very first client was a 11 year old girl - turns out her landlord was selling her to truck drivers passing through, and she had a meth habit. SHe already had a police record. Her family life was difficult. One day I sat her down and painted the grimmest picture I could of her future, pregnancies - welfare-health problems and an early death all alone. I helped her get involved with a local church(that I was not personally a member of), and they helped her go on a mission for the church to another state and live. Getting away from the environment helped her so much - a year later she returned and came by my business to thank me for how much it changed her life and that I probably literally saved her life.

Insurance reimbursement will be the same roughly as a big city, but the cost of running a business will be mmmuuuucccchhhh less. You will find you can get decent help by paying just a little above minimum wage for someone to answer phones. So your profit will be much higher. Malpractice will be lower for sure.

If you open yourself, and are not afraid to get involved you will find living in a small town will give you the opportunity to be a superhero of sorts. Or you can have a nice quiet life as well.

 

[Doowai]

For people interested in rural medicine who are not from sufficiently rural areas . . . how do you pick a place? Do you just say "Montana sounds cool!" or look through ads? How do you know if a place that size already has sufficient physician coverage?

I grew up in a relatively small place (city of about 90,000 but I was way out in the suburbs) and think rural family medicine could be interesting, but have no idea how one goes about deciding on a place to practice after residency.

I picked the town with 2 things in mind - one was it was close to my parents, and secondly it was the only place that had a business for sale that I could afford to buy. I realized the profit potential of buying that business. I bought it and made a ton of money. After 7 years I sold it literally for over 10 times what I paid for it.

I hired staff for just a bit over minimum wage, that was harder workers than what I have paid over twice as much for in my current city of 7 million.

But I picked it simply by looking for businesses for sale in the area I wanted to live (Missouri) and then finding the only one I could afford.

 

[3dtp]

I am also thinking about country life as a family physician (currently an MS1). Let me put a twist on things by asking this ...

Does anyone have any experience with (personal or friends) home schooling? Let's say one of the two parents (or significant other) has the ability to home school a child, is this a wise choice? I am sure there are many questions about social skill development, diversity of activities etc etc. What are peoples' thoughts on home schooling??

Yes. The youngest of my med school class, a whopping 18 year old was home schooled. He was kind, gracious, well educated, articulate and an all around good guy who excelled in med school.

I have a couple who are very good friends who have also home schooled their kids. I took one on a tour of a radiation oncology department and was astonished at this 13 year old's level of understanding of the physics of radiation and the sophisticated questions she asked. Her parents are bright, but this was totally unexpected. She was also articulate, far more broadly knowledgable than most 13 year olds and very open minded.

Her son is likewise excelling in college entering at 17, as did I from the public schools in my rural community. Teaching excellence comes from knowledge, willingness to learn new material to teach it, patience in helping someone less gifted in a subject master it, and patience with yourself when you have trouble mastering something you wish to teach, and like learning, perseverance to mastery.

 

[lilnoelle]

I'm bumping up an old thread here... I wish this forum had more "action". It would be nice to find out more of what rural practice is like.
I'm pretty interested in rural primary care. Its what drew me to medicine in the first place.... although I do occasionally get enticed by other specialties, rural primary care is an exciting option for me.
I grew up in rural Iowa. My father is a farmer and I went to a school with <40 people in my class. I loved living on the farm and while I didn't particularly like school, I don't think that my school was BAD, I just didn't handle the small town cliquishness of my high school very well.
I think the farm is a GREAT place for kids to grow up and can't wait to move to a rural area so my kids can appreciate it. There is really nothing better than the freedom of playing in the open air, exploring the woods behind the house, walking two to three miles to see the next door neighbor, and seeing the stars at night.

 

[Farmer Jane]

I'm bumping up an old thread here... I wish this forum had more "action". It would be nice to find out more of what rural practice is like.
I'm pretty interested in rural primary care. Its what drew me to medicine in the first place.... although I do occasionally get enticed by other specialties, rural primary care is an exciting option for me.
I grew up in rural Iowa. My father is a farmer and I went to a school with <40 people in my class. I loved living on the farm and while I didn't particularly like school, I don't think that my school was BAD, I just didn't handle the small town cliquishness of my high school very well.
I think the farm is a GREAT place for kids to grow up and can't wait to move to a rural area so my kids can appreciate it. There is really nothing better than the freedom of playing in the open air, exploring the woods behind the house, walking two to three miles to see the next door neighbor, and seeing the stars at night.

I grew up on a farm as well (could you guess? ). IMO, there is no better lifestyle. My dream is to teach nursing part time and farm full time--I joke that I'm in nursing to support my farming habit. In my hometown, there are quite a few doctor/farmers.

 

[lilnoelle]

I grew up on a farm as well (could you guess? ). IMO, there is no better lifestyle. My dream is to teach nursing part time and farm full time--I joke that I'm in nursing to support my farming habit. In my hometown, there are quite a few doctor/farmers.

My brother is a dentist that will probably take over my dad's farm when he dies. He (my brother) already owns 100 acres, 1/2 of which is wooded and 1/2 of which my dad farms.

 

[Farmer Jane]

My brother is a dentist that will probably take over my dad's farm when he dies. He (my brother) already owns 100 acres, 1/2 of which is wooded and 1/2 of which my dad farms.

That's very much like us. Our farm has been in the family since 1883. We haven't dairy farmed since my dad died, but my mom has since remarried and she and her husband started a small beef cattle herd three years ago. My brother (who is currently deciding between med school and research) and I want to take over at some point. Far less than 1/2 of our land is wooded, so we've been planting trees by the thousand on all the hilled areas. The goal is to have all the hills forested and use the flatlands for grazing livestock.

 

[HarveyCushing]

I am also interested in rural/small town medicine. I will be doing a rural rotation this summer and hopefully it will give me a good idea of what it is about. I wonder, do most people who are interested in rural medicine go to residency programs with a specific rural track? Will that really pay off as far as training and experience?

 

[NewmansOwn]

I am also interested in rural/small town medicine. I will be doing a rural rotation this summer and hopefully it will give me a good idea of what it is about. I wonder, do most people who are interested in rural medicine go to residency programs with a specific rural track? Will that really pay off as far as training and experience?

Well sure. You want to go to an unopposed program that teaches you full-scope FM with lots of procedures/OB. A little bit of emergency medicine training during your stint would be helpful, as well. An underlooked aspect is probably some basic business and tax knowledge, as well as some training to become an effective community leader and educator.

But this thread is about life in the country, not work in the country -- make yourself a whiskey sour and plop on your straw hat.

 

[HarveyCushing]

Well sure. You want to go to an unopposed program that teaches you full-scope FM with lots of procedures/OB. A little bit of emergency medicine training during your stint would be helpful, as well. An underlooked aspect is probably some basic business and tax knowledge, as well as some training to become an effective community leader and educator.

But this thread is about life in the country, not work in the country -- make yourself a whiskey sour and plop on your straw hat.

Sorry for that, but thanks for the comments. Too bad these threads don't see more action.

 

[NewmansOwn]

Sorry for that, but thanks for the comments. Too bad these threads don't see more action.

Amen to that. I'd love to see more, but everyone else seems more interested in highly specialized urban-based stuff -- I guess we're the minority in medicine these days...

 

[sophiejane]

Life and work in the country are pretty hard to pull apart. You have to have one to have the other.

To answer HarveyCushing's question, no, you don't have to choose a program with a specific rural track. In fact, I don't think it's necessary at all. I believe it's better to train in an urban setting so you can see everything and do a lot. You want good procedural experience, plenty of volume, good clinic, ample time to learn casting, sutures, basic radiology, get comfortable with codes, and OB if you want it. That's a lot. If you do choose a program with a specific rural track, make sure you are going to get the volume and hands-on that you need to be prepared for that wonderful country life you seek.

 

[HarveyCushing]

I am sure those of you interested in rural medicine have already come across Dr. Bowman's site on rural health. In case you haven't here it is: http://www.unmc.edu/Community/ruralmeded/. I have found it really informative.

 

[mestielest]

Hi! I'm not from USA but now I'm working in a rural primary care center in my country(turkey) and maybe my point of view can give some info about rural settings. Total population of the town I work is approximately 15000 and center population is 2500. I am 120 *** away from the nearest city. I am single, so I cant give a idea about family life or children.

In a small town everybody know everybody.And as flighterdoc said everybody is someones friend, relation etc. So never complain, never argue, never fight. If you get any problem try to avoid or get help from some local people who is respected in that town. If you have a "real" problem with someone, call police.

Go and meet with local police chief, army commander, prosecuter etc etc They will be your friends in rural area. In my country doctors are in government job. We spend a great time with forensic and administrative. I dont know the situation in US but in here, doctor is a part of state crew. So have a good association with others.

Everybody has his/her own job and does that job in his/her own way. So your old life is not their problem. And you are "the" doctor. Try to make your job as good as possible. Try to never be in "I dont know this" situation but also dont take unnecessary risks. Local people can smile to your face and at the same time they may make your gossip or may claim you. So dont give them that chance. Write everything and try to make everything in time and good.

Educational standarts are mostly bad in rural. Rural practice is a problem for children. Also rural areas are not very comfortable for women. Also for you. This may change from town to town. In my coutry, seaside is more open but if you are in a eastern town(like me) when you "just walk", people look to you. If you are women its worse. People go out for a "work" or "job" mostly. Try to find something to have a good time in home. Also there are some very funny people in towns. Not be very informal but spend some good time with local people.

If you are a single man, be careful. Every female you see is someones daughter, sister, mother or wife. And If you dont want to marry with a girl in two months of time, simply stay away.

You wil taste some very good local food/drink which you can not find in a big city. This is really good. For example in my town there are very good honey, pomegranate and wine. You probably hardly find that "natural tasting" foods in big city and if you find it would be three-four times expensive than local price. If you want to buy some "specific" thing. Go to a local market and place an order. If you want to go to a hipermarket and buy everything you see then go to city in a holiday.

If you behave them good, show your respect to their life style then they will respect to you, love you and you will have some good time in their town. After moving from them you will remember that era of your life as a "funny-hard-exciting-beatiful" memory.

 

[Sugarrush]

So, I am really excited about rural medicine. Both my husband and I have big plans for our life in the country and we can't wait to get out of the city.

We have wonderful friends in the city, however, and we enjoy going out on the town occasionally, so we plan to be close enough so we can get into the city for our urban fix once a month or so. But, we still want to be an active part of our community and blend in as well as we can.

My question is for those of you who have grown up in small towns. I know how closely knit small communities are--having spent several months of my rotations in one. I've heard that it's hard to break into that closeness if you are new in town, however. Have you found that to be true?

Also, we are pretty left of center politically...though we certainly aren't activisits--i.e., bumpersticker/tshirt/yard-sign types. We have both travelled a lot and are way overeducated, and I guess we like to think we are pretty worldly and open minded people. I know that small towns, particularly in the south/southwest tend to be pretty conservative, but we do get along with lots of different types of people (as evidenced by the parties we throw for our friends, where no one knows each other!).

Is there any hope for us to find friends and like-minded people in a small community?

By small, I mean 6-7K, 1-2 hours from the nearest large or medium sized city.

And what about schools....? Are they as bad as people say?? We don't have children yet, but want to soon...

Sorry for the ramble. Looking forward to your replies...

Sophie,
As a Southerner, a former home-schooler, a Medical Student, and someone who leans more than a little to the Right politically, let me take a stab at answering some of your questions. (Although other people have done a great job already)

I grew up north of Atlanta, Georgia, and went to school in small town SC. My wife is from a town in SC that is so small, it's smaller than a really small thing. (Step I in 10 days, so my writing skills are suffering a bit.)
I have lived and experienced the "small town Southern life" after coming from a relatively urban environment.

Your politics.

Down here in Southern Fla, everyone is a Northerner or a Yankee. So being Conservative like we are, we tend to stick out. But, I have yet to be hit in the face by a drive-by tofu, nor has my truck vandalized by random gangs of eco-terrorists.
Things will be similar for y'all in the South. As long as you're polite about it, everyone gets along. As someone said earlier, most of us vote Conservative, not because we're Republicans, but because we just want to be left alone by the Government. So as long as you avoid wearing t-shirts with phrases like "I heart Stalin", you'll be fine. Remember, our whole country was founded on the principle of " Go away and let us take of our selves thank-you very much!"

Schools.
Here, there is a problem. My wife came from one of the worst school districts in the country.(literally) She managed to graduate from Undergrad w/ a 4.0 in a competitive Biology research program. You just have to work hard.
I homeschooled up until late middle-school. The public school systems are garbage back home. So I got a great history, english, art, art history, ancient history, literature, geography, religion education. (Guess what my mom was interested in?) My math and science...not so good. Luckily, we had a tutor for those, and I was involved in a home-schooling group once a week. Once I got to school, it took me less than a semester to adjust. I'm in Med School, and doing fine. In fact, I chose a PBL program and loved it because of my past.
Like someone said earlier, school is NOT a place to drop off children and pick up educated adults 13 years later. As a parent, you have to be involved every single day with what they are doing, what they are learning. That doesn't change, no matter where they are learning, in public school, or your living room.

Church
If you don't go, don't go. Most people don't care. Most of the people who do care, only care because they like you, and care about you. The small minority who are mad at you because you don't go? They should probably pay attention in church
Just be respectful of peoples beliefs. I don't run around knocking people's turbans off at the campus Hindu meetings. Don't use Jesus' name in vain around us. Common respect.

The "Small Town Glass Box"
Sometimes, it's really annoying. But generally, I never did much that I would be ashamed of people knowing about, so it didn't matter if someone knew. The times you do need privacy, shut the drapes. If you don't gossip, then it'll eventually die down around you. You have to remember that the community is an actual community. People are involved in each others lives in the Small town. In the big city, you can live next to the same person in the same apartment for 5 years, and not even know their name. It's like 4 million individuals all alone in a tiny area. In a small town, it's 4 thousand all together in a huge amount of land.
You may hate it, but sometimes it's a help. When your house catches on fire at 3 a.m., your neighbors are up and running buckets before the volunteer fire-department even makes it to the station. When you're out of flour for the cake you're making, just run next door. It's what America used to be in a lot of ways.

Drugs and teen pregnancy are a problem, but that's the case everywhere at this point. Educate your kids young, and you won't have any problems.

Enjoy living in a place where people genuinely care, where you are more than just a random doctor, you are THEIR doctor.

I'm counting the day until I can head back to the South, and get back to open land.

p.s. If you do head down South, hole-in-the-wall restaurants are the way to go. We have the best Barbq there is, and no one else seems to have figured out how to properly make the Tea

 

[235750]

I don't run around knocking people's turbans off at the campus Hindu meetings. Don't use Jesus' name in vain around us. Common respect.

Sikhs wear turbans, not Hindus.

 

[deleted87716]

Sophie,
As a Southerner, a former home-schooler, a Medical Student, and someone who leans more than a little to the Right politically, let me take a stab at answering some of your questions.

This is a really old thread. The OP was five years ago. Sophiejane hasn't signed onto SDN in over two years. She's currently practicing rural FM somewhere deep in the heart of Texas.