Practicing Rural Medicine/Surgery

[Awesome Sauceome]

I am going to be applying this next cycle and I have recently been trying to get all of the information that I can on rural medicine. Is anyone on this forum on rotations in any rural med programs or locations that would be able to comment about it?
I have read a couple of other threads about it, but they are kind of old and I just want to get more of a feel of the pros/cons, interesting things about it, bad things about it, how the ACA will effect it etc.

Unfortunately I moved to the city for a job, I dont know if there is any way I would be able to shadow a rural doc from where I am. But I was born and raised in a town of like 10,000 people, 2 docs, 1 mcdonalds, 2 gas stations... that kind of thing. I am really interesting in finding out everything that I can about practicing both rural medicine and maybe rural general surgery (not sure if any other specialties are particularly successful in rural med?) So yup, any input would be awesome. Any sort of "day in the life" type of stuff would be ridiculously awesome.

Thanks so much!

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[sonofva]

pretty much any of the primary care specialties are suited to rural medicine. it really depends on your level of interest in OB that will guide your specialty selection (OBGYn where you will do ALL OBgyn, Family where you will do some, or IM where you will do none). I will say that if you're positive that this is the route you want to take, you should seriously consider the NHSC scholarship.

 

[Awesome Sauceome]

I mean thats one of the reasons why I am interested to find more info on the field. Many of the osteopathic and even some of the allopathic schools that I am applying to have rural tracks, but I would obviously want to find out as much as I possibly could before that time.

I mean what it seems like from a couple of the threads that I have found (unfortunately I have found ONLY a couple of threads), that it is interesting because you really have the ability to become a jack of all trades (some FM, IM, EM, OB etc). Which I find pretty cool. I guess the thing that I am really curious to find is some more information on rural general surgeons. I have heard things that vary wildly. Some people say its horrible, some people say they know people that left a top attending position at a large institution to go rural and they love it.

In general I am just trying to find some more information on that stuff.

 

[Elevencents]

Cabinbuilder is who you want to talk to.

 

[Mosonik]

Rural tracks and other such opportunities in medical schools exist for you to experience these things first hand and answer the questions you are seeking answers to right now. I applaud your interest in rural medicine, the need is great, but the calling is a serious commitment and the only way you will discover if it is truly for you is by doing it. Good luck

 

[cabinbuilder]

As you may or may not know, I make my living as a rural and frontier locums FP. Yes, I am jack of all trades but I never got into doing scopes. As far as general surgery in rural practice, it really depends on the area and the need. Some rural areas do employ a full time general surgeon because they are the central community hospital that treat a greater area of surrounding smaller towns. Other areas are too remote to support the salary of a general surgeon and they have a surgeon who would travel to their site maybe once a month for 2-3 days. 2 of those days would be scopes/surgery. The first day would be patient consultation.

Everyone's vision of "rural" is different. Mine is a town of <5,000, yours seems larger than that. I grew up in a town of 500. Not sure what else you need to know?

 

[sonofva]

I worked with a rural general surgeon for 2 years in super BFE . We were at a very small community hospital for most of the week that served a huge watershed area. We also went to a one OR surgical center occasionally to take elective cases. the case load was primarily bread and butter g-surg cases. It was busy.

I will say that the "good old days" of general surgeons cutting on everything from the neck down are gone. So if you have dreams of doing everything from ortho to gyn to abd to thoracic, i'm sorry to burst your bubble.

however it was rewarding work and the pay for the surgeon was awesome because it was a location that few people wanted to go. I think your enjoyment of the experience overall will depend on whether you can tolerate living in a small town. i believe that people who go into rural practice and hate it are generally people who end up there due to circumstances beyond their control.

 

[alpinism]

I worked with a rural general surgeon for 2 years in super BFE . We were at a very small community hospital for most of the week that served a huge watershed area. We also went to a one OR surgical center occasionally to take elective cases. the case load was primarily bread and butter g-surg cases. It was busy.

I will say that the "good old days" of general surgeons cutting on everything from the neck down are gone. So if you have dreams of doing everything from ortho to gyn to abd to thoracic, i'm sorry to burst your bubble.

however it was rewarding work and the pay for the surgeon was awesome because it was a location that few people wanted to go. I think your enjoyment of the experience overall will depend on whether you can tolerate living in a small town. i believe that people who go into rural practice and hate it are generally people who end up there due to circumstances beyond their control.

Yep. Rural GS is pretty much basic bread and butter GS with albeit a greater variety than city surgeons. Stuff like appys, choles, hernias, hemorrhoids, SBOs, etc… Maybe some basic trauma assessment/stabilization if you're at a level 3 or 4 trauma center. Most of the complex cases are sent to the nearest big city. Its long hrs with lots of call since you'll likely be only 1 of 2 or 3 surgeons in town.

 

[cabinbuilder]

When I was in Tillamook, OR they have 2 general surgeons and were busy all the time, on call all the time. However, they had the choice to ship folks to a larger facility if the case was deemed to be high risk or the patient was in a crash and burn mode. I had a young girl I saw in urgent care with black urine. She was in liver failure with ascending cholangitis. I sent her to the ER, the ER call the surgeon, who said no, and the patient was shipped to a larger facility.

 

[Awesome Sauceome]

Yea I imagine it is absolutely too early, just trying to get a general feel for it. I am really trying to go in completely open to any field.

It is like, trying to look far down the road of my life and see what types of things will make my personal life enjoyable and what kinds of things will make my professional life enjoyable. I think personally I dont see myself living in a city. I grew up with the rolling hills and fields, I have had one primary care doc from birth who has been a friend and mentor and his work I suppose would be considered more rural. So from that standpoint I could see myself doing that. I wouldnt mind going to a city for school and/or residency but after that I think long term I would absolutely want to live more rural. Whether or not this means practicing in the rural location or making a commute and driving to a city is a different story.

Professionally I have no clue realistically. I know I want to become a physician, that much is clear to me through experiences I have had. But what specialty and what type of practice I would want to end up working in still feels so far away. And I would be irresponsible gunning down that path without having tried a lot of stuff (which I figure 3rd year is for).

I guess I am concerned with what the differences would be between say an urban FM/IM and rural FM/IM, as well as the same for general surgery in those two locations. Is it essentially the same type of practice? How much broader are the things that you practice? Are hours similar? Patients similar? Are there any type of real frustrating things about either locations of practice?

 

[Awesome Sauceome]

Hmm that is interesting, so it seems for GS that its more of a question of if I would want to go more specialized or if I would want to go more broad. That is challenging....

How specifically would that work then for IM or FM which as I understand tend to be a little more generalized to begin with, like even in urban settings (assuming one does not do a fellowship such as cards or something). Would the jobs be pretty darn similar then?

 

[Awesome Sauceome]

So I am sitting here thinking, and I am realizing I am struggling to express what I am trying to ask, but I think I found it:

Is there as specific professional reason why one would choose urban or rural over one another, or is it more specifically that one would pick one or the other based on desired living location?

 

[cabinbuilder]

So I am sitting here thinking, and I am realizing I am struggling to express what I am trying to ask, but I think I found it:

Is there as specific professional reason why one would choose urban or rural over one another, or is it more specifically that one would pick one or the other based on desired living location?

I do rural because I HATE the city, HATE the traffic, hate the lifestyle, folks seem more "entitled". Rural places are really laid back, the people are so happy to have health care, happy to not have to drive 3 hours to the next doctor. Rural you have more freedom in FP as far as procedures you can do since there is no one else who is competing with you.

 

[Awesome Sauceome]

I do rural because I HATE the city, HATE the traffic, hate the lifestyle, folks seem more "entitled". Rural places are really laid back, the people are so happy to have health care, happy to not have to drive 3 hours to the next doctor. Rural you have more freedom in FP as far as procedures you can do since there is no one else who is competing with you.

So technically it is a little bit of both then? Personal reasons because you hate the city, but professional because you actually get to essentially do more than your urban counterparts?

Sounds like a pretty sweet deal to me. That would be my two reasons for having interest in it heh

 

[cabinbuilder]

So technically it is a little bit of both then? Personal reasons because you hate the city, but professional because you actually get to essentially do more than your urban counterparts?

Sounds like a pretty sweet deal to me. That would be my two reasons for having interest in it heh

I suppose you can look at it that way. I have become the more procedural side of family practice/ ER/Urgent care, etc, not the women's health/OB side. You can cater FP to what you like to do.

 

[Awesome Sauceome]

what types of procedures do you do? Like are you essentially a non-emergent ER doc?

I guess I should add, without shift work?

I dont think shift work is all its cracked up to be, especially if you are a 60 year old doc still having to do 12 hour overnight shifts

 

[cabinbuilder]

what types of procedures do you do? Like are you essentially a non-emergent ER doc?

I guess I should add, without shift work?

I dont think shift work is all its cracked up to be, especially if you are a 60 year old doc still having to do 12 hour overnight shifts

For me it all depends on the job I am on. I am a travelling rural doctor. I go to a site that needs help. The shifts depends on their needs. I know ahead of time what they are looking for so that determines whether I "apply" for that temp position.