Rural Focus - Specialty Options?

[u_raptor]

Hey everyone,

Now that I am finally admitted to med school, I am trying to really dive deep into researching the different specialties so I have at least an inkling of an idea for when I talk with mentors/advisors etc in first and second year. I would really love to end up practicing in a rural area (I know the definition is subjective, but for the sake of discussion lets say rural means there's only a small county hospital within realistic driving distance or something like that). What kind of specialties would provide for a lifestyle where living in a rural area is realistic? I know basically any of the primary care areas would be ideal for that, but what about the different surgery specialties, radiology, etc.

Could a more specialized surgeon be able to work rural, like a vascular or CT? Could an oncologist? What specialties would tend NOT to lend itself to realistically having the option of living in a rural area? I am honestly just trying to get an idea of what could and could not be a possibility, should I want to limit myself to rural life in the future. Right now I am leaning a bit into an interest in some type of surgery (be that general or a subspecialty), although I am open to anything.

Thanks for any help!!

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[Mkif586]

Are patients in rural areas any different from the rest of the population? Don’t they have lungs, hearts, brains that require treatment? My non-expert opinion is that any physician would be in demand in rural areas as well as anywhere in the world.

 

[u_raptor]

Are patients in rural areas any different from the rest of the population? Don’t they have lungs, hearts, brains that require treatment? My non-expert opinion is that any physician would be in demand in rural areas as well as anywhere in the world.

I was more thinking that some areas may not have the infrastructure to provide for both funding a physician of a certain specialty, or maintaining the equipment for one, or have the demand.

 

[walterwhite3556]

Rural areas need general surgeons

edit: also vascular & ortho surgeons, ophthalmology, urology etc... (rural areas have a growing number of older and sicker patients coupled with more surgeons approaching retirement age)

 

[u_raptor]

Rural areas need general surgeons

edit: also vascular & ortho surgeons, ophthalmology, urology etc... (rural areas have a growing number of older and sicker patients coupled with more surgeons approaching retirement age)

From what I have read it definitely looks like gen and ortho has a need in rural. Didn't think of urology! Wonder if the need will still be there in about 10 years (when I am done with med and residency lol).

 

[gulli_97]

It's very possible. For example, down in Temple, Texas, there's Baylor Scott and White. It's a huge level 1 trauma center, multi-specialty, and a teaching hospital with Texas A&M.

There's also the opportunity for private practice, you'd just have to build a referral base but that shouldn't be too hard if you're the only specialty provider.

 

[LizzyM]

You need to look at the population of the hospital's catchment area (e.g. the hospital draws patients from this county or from counties A B and C. Then you need to look at the incidence of the bread and butter issues of a specific specialty. Also consider that family medicine (and general internal medicine and general pediatrics) will treat uncomplicated cases of common conditions (e.g. arthritis, infections, asthma, depression, sports injuries, diabetes, etc etc). Will there be enough demand for a specific specialty to justify establishing an office in that area? Hospitals know what the demands are in their area and will recruit to meet a need in their community. It is far too early to be thinking about this.... better something to look into after 3rd year of med school.

And btw, the population of Temple TX is over 70,000 so it would not meet my definition of rural by any stretch of the imagination.

 

[u_raptor]

You need to look at the population of the hospital's catchment area (e.g. the hospital draws patients from this county or from counties A B and C. Then you need to look at the incidence of the bread and butter issues of a specific specialty. Also consider that family medicine (and general internal medicine and general pediatrics) will treat uncomplicated cases of common conditions (e.g. arthritis, infections, asthma, depression, sports injuries, diabetes, etc etc). Will there be enough demand for a specific specialty to justify establishing an office in that area? Hospitals know what the demands are in their area and will recruit to meet a need in their community. It is far too early to be thinking about this.... better something to look into after 3rd year of med school.

And btw, the population of Temple TX is over 70,000 so it would not meet my definition of rural by any stretch of the imagination.

Thanks for the info! I realize it's pretty early, just wanted to have some ideas!

 

[LizzyM]

Thanks for the info! I realize it's pretty early, just wanted to have some ideas!

Looking around at some super rural counties and their local hospitals, it seems that in some areas, the physician comes in on a schedule and serves people in a number of hospitals like a circuit rider. As long as you have transportation, you can live in the boonies and serve a rural population.

 

[u_raptor]

Looking around at some super rural counties and their local hospitals, it seems that in some areas, the physician comes in on a schedule and serves people in a number of hospitals like a circuit rider. As long as you have transportation, you can live in the boonies and serve a rural population.

Interesting. By this do you mean it is similar to a locums type temporary deal, or more you work for several hospitals in one area and just rotate?

 

[Wolvvs]

Interesting. By this do you mean it is similar to a locums type temporary deal, or more you work for several hospitals in one area and just rotate?

I've seen one setup where an orthopedic surgery private practice group would rotate between several semi-rural hospitals. If the hospital needs an orthopedic surgeon only a few days per week, this sort of setup could work very well.

 

[AnatomyGrey12]

Ortho and GS especially, perhaps vascular, general ENT, and Uro would all be able to have a rural practice CT might be difficult because you would need to do enough surgeries to justify the hospital paying you and if your catchment area isn't big enough you won't have the volume. Same with plastics. Typically general surgeons do a lot of the thoracic stuff in rural settings, and punt the hearts to the closest city. Rural general surgeons typically also do vascular stuff, like fistula creation, access, etc. Some even do basic ortho stuff in certain settings.

I know an ENT resident that just signed a contract with a tiny hospital of 50 beds. He's going to be the only ENT covering like a 70 mile radius. The population of the catchment area is like 50k even though the town itself is only like 4k.

 

[u_raptor]

Ortho and GS especially, perhaps vascular, general ENT, and Uro would all be able to have a rural practice CT might be difficult because you would need to do enough surgeries to justify the hospital paying you and if your catchment area isn't big enough you won't have the volume. Same with plastics. Typically general surgeons do a lot of the thoracic stuff in rural settings, and punt the hearts to the closest city. Rural general surgeons typically also do vascular stuff, like fistula creation, access, etc. Some even do basic ortho stuff in certain settings.

I know an ENT resident that just signed a contract with a tiny hospital of 50 beds. He's going to be the only ENT covering like a 70 mile radius. The population of the catchment area is like 50k even though the town itself is only like 4k.

Thank you so much! Kinda confirmed my thoughts with CT lol. Seems like a really cool specialty, but I agree it would be hard to justify the presence of one in small rural hospitals for the most part...guess it would make sense for plastics to fall under that category too. Interesting to see GS may cover some of CT areas in those rural hospitals (obviously not the crazy complicated cases ofc).

And honestly that anecdote you provide sounds exactly like where I would like to end up

Thanks again!

 

[chemphysicsinstructor]

Looking around at some super rural counties and their local hospitals, it seems that in some areas, the physician comes in on a schedule and serves people in a number of hospitals like a circuit rider. As long as you have transportation, you can live in the boonies and serve a rural population.

This situation occurs where I live. The specialist is only present in one location on Tuesdays and then travels to another location on Wednesdays, etc. Our nearest hospital is 25 min. away. That is why I have a tourniquet, gloves, blood clotters, etc. in my car. You are on your own, so to speak.

From my perspective as a patient: The result is that certain specialties have long wait times (4-6 months) in order to get an appointment. So, if you need a specialist appointment, you need to drive to the nearest city (90-125 miles each way) to get a more timely appointment.

 

[u_raptor]

This situation occurs where I live. The specialist is only present in one location on Tuesdays and then travels to another location on Wednesdays, etc. Our nearest hospital is 25 min. away. That is why I have a tourniquet, gloves, blood clotters, etc. in my car. You are on your own, so to speak.

From my perspective as a patient: The result is that certain specialties have long wait times (4-6 months) in order to get an appointment. So, if you need a specialist appointment, you need to drive to the nearest city (90-125 miles each way) to get a more timely appointment.

Interesting. So I would assume that the long wait times means there is decent demand as well? Thanks for sharing as well

 

[chemphysicsinstructor]

Interesting. So I would assume that the long wait times means there is decent demand as well? Thanks for sharing as well

Yes. One reason could be that there are a good portion senior citizens who utilize the care. One also needs to consider the financial aspects of medicare/medicaid too.

 

[Cornfed101]

Typically the more specialized you become the more difficult it would be to practice in a rural setting. If you do any fellowship training it may not be put to use. My dad is the only ophtho in an area of over 40k square miles. He only has time for general ophtho. He punts more complicated cases to the neighboring state.

 

[u_raptor]

Yes. One reason could be that there are a good portion senior citizens who utilize the care. One also needs to consider the financial aspects of medicare/medicaid too.

For sure. I am curious how demand may change as demographics change and by the time I actually get to attending lol.

The National Rural Health Association might have some info

Thanks! Will check it out now!

 

[DokterMom]

And btw, the population of Temple TX is over 70,000 so it would not meet my definition of rural by any stretch of the imagination.

Guessing you've never been there. The imagination boggles...

 

[u_raptor]

Typically the more specialized you become the more difficult it would be to practice in a rural setting. If you do any fellowship training it may not be put to use. My dad is the only ophtho in an area of over 40k square miles. He only has time for general ophtho. He punts more complicated cases to the neighboring state.

Makes sense. Upside I guess is less years to tack on to residency haha. Seems to be in line with what everyone else is saying.

 

[LizzyM]

Guessing you've never been there. The imagination boggles...

No, I haven't been there but the population density is 1,000 per square mile which is similar to Oklahoma City or Jacksonville Florida. And 70,000 people in an area of 70 square miles is enough to run a decent size hospital was the point I was making. It is not like running a hospital in an area that big with a population of 4,000.

 

[DokterMom]

No, I haven't been there but the population density is 1,000 per square mile which is similar to Oklahoma City or Jacksonville Florida. And 70,000 people in an area of 70 square miles is enough to run a decent size hospital was the point I was making. It is not like running a hospital in an area that big with a population of 4,000.

I was being snarky. Sometimes rural is a state of mind....