Rural area Physicians

[deleted600623]

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Hi all,

I'm curious as to what route is better for wanting to live in a rural area while practicing medicine. Would it be better, job wise, to simply go into primary care or internal medicine residency and not specialize further in a fellowship or specialize in a fellowship? I guess what I'm trying to ask is would it be a waste of time to go into a fellowship if I want to end up living in a rural area to practice?

Sorry if the question is confusing. Thanks for the help!

 

[deleted407021]

I'd imagine you could find a location with a fairly large medical center surrounded by rural areas. I live in the country and I'm within 15 minutes of many different sub specialists offices.

 

[Stagg737]

Hi all,

I'm curious as to what route is better for wanting to live in a rural area while practicing medicine. Would it be better, job wise, to simply go into primary care or internal medicine residency and not specialize further in a fellowship or specialize in a fellowship? I guess what I'm trying to ask is would it be a waste of time to go into a fellowship if I want to end up living in a rural area to practice?

Sorry if the question is confusing. Thanks for the help!

I'd say no, especially if you go into something like endocrinology. Depending on how far out in the boonies you are, you could be the only physician with that specialty for a hundred miles, so you could potentially be referred all of those patients. Chances are you'll still end up as the FP/OB/Gyn/Peds/jack of all trades guy for your town and surrounding area anyway, but you could also get a lot of patient referrals for your specialty as well.

Then again, it completely depends on what your career goals are and where you want to end up practicing.

 

[Taddy Mason]

Like others have alluded to, it depends on your definition of rural and where you end-up. For example, most people on SDN would consider western and northern MN rural and ND rural. However, if you practiced in that area in towns with populations of 30,ooo-40,000+ doing a fellowship to specialize would be pretty reasonable, plus you'd easily be able to do outreach to smaller communities if demand existed and you were truly interested. Practice in a town smaller than that where you'd more likely be at a critical access hospital and a fellowship wouldn't be worth it. You'd rarely put to use the skills gained from more specialized training and the hospitals and clinics in those regions very likely wouldn't be equipped for more advanced procedures and testing.

Also, if just living in a rural area is what you're interested in and you have a strong interest in specializing, commuting (driving or flying) to larger areas where your services are more likely to be in demand is always an option.

 

[Terry Toma]

There are some major medical centers in relatively rural areas. You could literally live on an Amish farm and work at Penn State's 500 bed hospital/level 1 trauma center with a commute of about ten minutes. Such a hospital would obviously employ just about every kind of specialist.

There aren't as many rural medical centers as urban, but there also aren't as many specialists seeking out jobs in rural areas.

 

[deleted600623]

Thanks for all the advice! I guess another question is what specialties are most needed in rural areas? Salaries for primary care in rural areas when adjusted for cost of living is very attractive but I'm not sure if I could see myself doing primary care on a daily basis as a career.

 

[lyana]

I think one specialty that is extremely needed in the rural areas is physiatry ( PM&R) no joke. Hard labor, farming, gardening, aging population,etc therefore, ----> lots of injuries, back pains, etc.
Open PM&R clinic with physical therapist/massage therapist/ and you will be golden...

 

[Goro]

This is a job for @cabinbuilder !!!

Hi all,

I'm curious as to what route is better for wanting to live in a rural area while practicing medicine. Would it be better, job wise, to simply go into primary care or internal medicine residency and not specialize further in a fellowship or specialize in a fellowship? I guess what I'm trying to ask is would it be a waste of time to go into a fellowship if I want to end up living in a rural area to practice?

Sorry if the question is confusing. Thanks for the help!

 

[deleted600623]

@Liana Interesting. I wouldn't have thought of PM&R. Thanks for the advice!

 

[lyana]

Absolutely, we have patients driving 100-200 miles to see physiatrists on the regular bases, and they are typically booked out a few months ahead.

 

[Taddy Mason]

Thanks for all the advice! I guess another question is what specialties are most needed in rural areas? Salaries for primary care in rural areas when adjusted for cost of living is very attractive but I'm not sure if I could see myself doing primary care on a daily basis as a career.

Psych and general surg are also in higher demand in rural areas. Psych in my area can easily start around $300k (and this isn't for office based cash only practices) - downside is workload and issues with ancillary care and community services. I'm not sure what GS starts at for rural positions, but based on the handful of rural surgeons I've talked to I do know that you definitely have the upper hand in negotiating call and the terms of your practice. Downside of rural GS is significantly limiting your scope of practice and having to refer out for even bread and butter cases just to CYA in case the **** hits the fan. Again, a lot of this is highly contingent on where you would like to practice (and your definition of rural), what the needs for certain areas are, and what you're willing to sacrifice both in terms of practice and lifestyle.

 

[deleted600623]

@Liana Wow that's impressive. Obviously I need to get into medical school first but just based on who I've shadowed, I've really liked pulmonology and cardiology so would those be worth it? It seems to me like cardio would be more worth it than pulmonary but not sure at all.

 

[lyana]

Cardio is always a good option, I feel like. 😉

 

[deleted600623]

@Walter Lance Very true. The southeast or northwest like Idaho would be places that I would enjoy living. Idaho has rural towns ranging from 200 to 50,000 but I think living in a town of 5 to 10,000 would be good. I think lifestyle will be a big proponent but salary is also something that would play a pretty big role too. Primary care is attractive but I don't think I would want to be a jack of all trades kind of physician.

 

[Taddy Mason]

@Liana Wow that's impressive. Obviously I need to get into medical school first but just based on who I've shadowed, I've really liked pulmonology and cardiology so would those be worth it? It seems to me like cardio would be more worth it than pulmonary but not sure at all.

Cards and pulm would likely be based out of a town of at least 30,000-40,000 minimum and would probably entail a lot of outreach work.

 

[Taddy Mason]

@Walter Lance ...but I think living in a town of 5 to 10,000 would be good....

Towns like that likely wouldn't support specialties like cards and pulm (as you mentioned above) unless they were in close proximity to a much larger town and hospital facility.

 

[cabinbuilder]

I think one specialty that is extremely needed in the rural areas is physiatry ( PM&R) no joke. Hard labor, farming, gardening, aging population,etc therefore, ----> lots of injuries, back pains, etc.
Open PM&R clinic with physical therapist/massage therapist/ and you will be golden...

I totally disagree with this. Lets take the folks in Cody, WY where I have worked off/on for the past year. Every farmer, every cowboy, every rancher, etc. has lived with their back pain for 30 years. It's part of their life and their existence. I will tell you right now, that NO ONE is going to take the time off to go see a PM&R guy unless they absolutely cannot walk and will go to the larger hospital 100 miles away anyway. Plus, all those folks are private pay or have no insurance and cannot afford a specialty doctor. Stick to the basics in rural areas where there is a definite shortage in FM/ER/IM/PEDS/PSYCH/GYN/ORTHO where you can do the most good with the poorest populations.

 

[cabinbuilder]

This is a job for @cabinbuilder !!!

See my other post. I can honestly say in 7 years of practice I have never referred a patient in a rural area to a PM&R guy. I don't even think I have ever met one in a rural area.

 

[Tenk]

One of my EDs is in a rural area and I see the craziest @*#$ ever there. It's fun!

Plus, I've found people in rural areas actually appreciate you more than inner city. I get about 10x more thank yous than I did at a 100,000 volume ED.

These areas usually DESPERATELY need specialists. So if you are a cardiologist, gastroenterologist, surgeon, etc, you will have no problem finding a job and making a hospital CEO very happy.

 

[andrek82]

Towns like that likely wouldn't support specialties like cards and pulm (as you mentioned above) unless they were in close proximity to a much larger town and hospital facility.

I trained in a rural area for my program, and the town of 10,000 had 4 cardiologists and 2 pulmonologists with 2 endocrinologists and lots of endo-oriented family docs. This was with referral population from the surrounding 20-30 miles. This is Northeast, not Idaho, so population density is different, but IM subspecialties (those above and others) do quite well in the various rural places I've lived.

 

[Taddy Mason]

I trained in a rural area for my program, and the town of 10,000 had 4 cardiologists and 2 pulmonologists with 2 endocrinologists and lots of endo-oriented family docs. This was with referral population from the surrounding 20-30 miles. This is Northeast, not Idaho, so population density is different, but IM subspecialties (those above and others) do quite well in the various rural places I've lived.

Yeah, I was talking more about the eastern portion of the northwest (e.g., Idaho) and the northern midwest, where the population is much more spread out (and where I'm more familiar with certain areas' healthcare needs and practice set-ups). The scenario you described doesn't seem too surprising for the northeast given the population density, like you mentioned.

At OP, again, this is why your definition of rural, areas you're interested in and the needs for those areas, and sacrifices you're willing to make are really important factors regarding your question. Also, as you're still pre-med, needs of certain regions and specialties could change drastically by the time you're finished with training.

 

[Mad Jack]

@Liana Wow that's impressive. Obviously I need to get into medical school first but just based on who I've shadowed, I've really liked pulmonology and cardiology so would those be worth it? It seems to me like cardio would be more worth it than pulmonary but not sure at all.

Hearts and lungs are always an issue no matter where you go. Even the smallest of hospitals usually has a few bed ICU, so there's a good place for a pulmonologist pretty much anywhere that isn't saturated. Cardiology is sort of the same deal- you're gonna have CHF patients wherever you go because hearts just kind of fail as we age, so don't think you'll go unemployed if you're willing to hit the sticks. But also don't plan to make a whole hell of a lot, care of the great number of uninsured or underinsured.

 

[deleted600623]

@Mad Jack That's true. The only tough thing about primary care in a rural area is becoming a "jack of all trades". I just don't believe I could be as effective as a physician in this sense. Maybe I'm wrong though.

 

[Mad Jack]

@Mad Jack That's true. The only tough thing about primary care in a rural area is becoming a "jack of all trades". I just don't believe I could be as effective as a physician in this sense. Maybe I'm wrong though.

You won't be, simply by virtue of procedure volume. But often you'll be all there is, if that's the road you go down, so your services will be much appreciated, even if you can't deliver a baby with the skill of an Ob/Gyn or provide the full services of a cardiologist.