Rural Practice vs suburbs/urban

[Soup]

Can anyone compare and contrast some of the differences between a rural practice versus one located in a heavily populated suburb or urban setting, e.g. patient demographics, procedures performed, hours worked, and income. Currently, I live in Kansas City and am trying to look into the future a little bit. Most of my experience has been in affluent suburbia, but I think I would like being a small town doc. At the same time, my wife is a level III NICU nurse and would like to remain within a reasonable (~45-60 min.) commute to a large enough hospital to keep her employed. Ideally, we can find a place that makes us both happy. Any information or advice is appreciated.

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[iatrosB]

Can anyone compare and contrast some of the differences between a rural practice versus one located in a heavily populated suburb or urban setting, e.g. patient demographics, procedures performed, hours worked, and income. Currently, I live in Kansas City and am trying to look into the future a little bit. Most of my experience has been in affluent suburbia, but I think I would like being a small town doc. At the same time, my wife is a level III NICU nurse and would like to remain within a reasonable (~45-60 min.) commute to a large enough hospital to keep her employed. Ideally, we can find a place that makes us both happy. Any information or advice is appreciated.

Income, usually higher if you are savy. Hours, usually MUCH higher even if you are savy. You are THE doc in rural areas and they come to you for everything at any time. That is the appeal as well as the drawback to rural medicine (it is double-edged sword). I have heard glory stories from rural FP's I've shadowed of people showing up at their house needing help or stopping their car as they drive through town. You are really never "off" in a rural area. For me, that sounds cool, for others not. Most rural FP's are overworked but still more content than the golf playing urbanite docs. Patient demographics are more varied for rural. You see literally everything cause no one else is there to steal your patients. In an urban practice for example, people are more likely to take their kid to a peds doc, whereas in a rural area there is no peds doc there. Same with people needing specialists. As far as being in KC, there are so many towns within one hour that are considered rural (I grew up in one), you get the best of both worlds. Good luck.

 

[Soup]

Income, usually higher if you are savy. Hours, usually MUCH higher even if you are savy. You are THE doc in rural areas and they come to you for everything at any time. That is the appeal as well as the drawback to rural medicine (it is double-edged sword). I have heard glory stories from rural FP's I've shadowed of people showing up at their house needing help or stopping their car as they drive through town. You are really never "off" in a rural area. For me, that sounds cool, for others not. Most rural FP's are overworked but still more content than the golf playing urbanite docs. Patient demographics are more varied for rural. You see literally everything cause no one else is there to steal your patients. In an urban practice for example, people are more likely to take their kid to a peds doc, whereas in a rural area there is no peds doc there. Same with people needing specialists. As far as being in KC, there are so many towns within one hour that are considered rural (I grew up in one), you get the best of both worlds. Good luck.

Thanks for the info iatrosB. I am wondering about a few things. First, why is income higher for rural docs? Aren't they reimbursed by the insurance companies at levels equivilant to their suburb counterparts? Is it simply that they do more income producing procedures due to the lack of competition from other specialists? Or, is there some other reason? Second, does the average patient's attitude toward their family doc differ from small to large town? How does call requirments differ between locations, generally speaking?

 

[iatrosB]

Thanks for the info iatrosB. I am wondering about a few things. First, why is income higher for rural docs? Aren't they reimbursed by the insurance companies at levels equivilant to their suburb counterparts? Is it simply that they do more income producing procedures due to the lack of competition from other specialists? Or, is there some other reason? Second, does the average patient's attitude toward their family doc differ from small to large town? How does call requirments differ between locations, generally speaking?

I am speaking from generalizations and limited but extensive exposure to rural vs. urban, keep that in mind.

Income difference is due to the volume of procedures, broad scope of practice, and lower cost of operation. All of these factors depend on the doc and the practice however, if the doc is business savy, he/she will do very well in a rural area.

Call is usually significantly greater in rural areas, generally less partners and less places for patients to go (you are THE doc).

As far as attitude, that depends on how good the doctor is. Generally though, patients are much more appreciative of the rural doc and less likely to leave them. In an urban area there is many docs to choose from, in rural areas you are THE doc.

Remember, these are generalizations.

 

[brewtcl]

Can anyone compare and contrast some of the differences between a rural practice versus one located in a heavily populated suburb or urban setting, e.g. patient demographics, procedures performed, hours worked, and income. Currently, I live in Kansas City and am trying to look into the future a little bit. Most of my experience has been in affluent suburbia, but I think I would like being a small town doc. At the same time, my wife is a level III NICU nurse and would like to remain within a reasonable (~45-60 min.) commute to a large enough hospital to keep her employed. Ideally, we can find a place that makes us both happy. Any information or advice is appreciated.

I'm not currently in med. school, but will start in the August 🙂

My prior experience has been in business w/ public health and private healthcare. Most of it has been in rural Georgia. So I can comment on some items but others I’ll leave to more experienced individuals.

I like rural medicine. I think a good thing to do is to ask for a break down from possible employers or practices of the past insurance or payment system to see what is actually going on. Often rural areas will have a significant portion w/o health insurance. Why? B/c their job doesn’t offer it. I.e. agricultural jobs, etc. However, there is a flip side. If the rural area is a bedroom community to a larger city or has a some kind of industrial enterprise you can have a population that has a higher percent w/ insurance. It all depends on the area. I have no idea w/ regards to the area you are looking at.

I would suggest going to http://www.census.gov/ and looking up the area you are interested. You can go to the right side and towards the bottom of page for a quick state and then county search. This will give you a good idea of the demographic break down. Further you can call the chamber of commerce of an interested area and get them to mail you information on the are you are interested in and ask them to outline the businesses and employment/unemployment status in the area.

I did see a fair bit of minor trauma w/ the rural area and has been either a turn-off or turn-on depending on the doc being recruited. If someone gets hurt they are likely to come to you, it depends on the other local healthcare that is available. I saw a lot of stitching done, minor breaks, etc. B/c the area I work in has a lot of agriculture, logging, and other industry that promotes those kinds of injuries.

I do like the patients attitudes better in rural areas. I agree w/ that they seem a lot more appreciative. The last item I would offer is doing a little self marketing in a rural area. Go to the major industry, local groups, or other areas and tell them you are there and what you do. I hope this helpful.

 

[bla_3x]

...if the doc is business savy, he/she will do very well in a rural area.

Is it as simple as just controlling your overhead, investing in your practice, etc?

 

[dj_smooth]

If I may add a couple things to look at that helped me. I am going into FP with the intention of doing rural fp. I wanted a broad range of practice, including c-sections, colonoscopy/EGD, seeing kids, ER work, etc. IMHO, I think rural areas is where FP thrives; not to say you can't do as well in other areas, but in rural areas an FP can do very well; other specialties just can't be supported because there usually isn't sufficient population base to keep them busy enough. I am currently reading a book called Caring for the Country : Family Doctors in Small Rural Towns by Howard K. Rabinowitz, ISBN: 0387209786. It provided insight into what rural doctors really do (it's A LOT).

The other resource I found helpful is Robert Bowman website http://www.unmc.edu/Community/ruralmeded. THere is tons of info on there about rural medicine and how badly rural Americal needs comitted docs. I guess I chose rural medicine because I also wanted to be in an underserved area doing something that I felt was helpful for others. I also thought it would be great training to go work in the developing world, another aspiration of mine.

Anyway, I hope I haven't bored you to death... 😴

Hope this helps

 

[Peeshee]

I am currently reading a book called Caring for the Country : Family Doctors in Small Rural Towns by Howard K. Rabinowitz, ISBN: 0387209786. It provided insight into what rural doctors really do (it's A LOT).

The other resource I found helpful is Robert Bowman website http://www.unmc.edu/Community/ruralmeded. THere is tons of info on there about rural medicine and how badly rural Americal needs comitted docs. I guess I chose rural medicine because I also wanted to be in an underserved area doing something that I felt was helpful for others. I also thought it would be great training to go work in the developing world, another aspiration of mine.

THANKS for the info. about the book! It sounds like good reading.

I am just wondering for those interested in rural medicine-- how do you establish yourself in a rural area/small town if you haven't lived there and are new there? Wouldn't the people have some kind of wariness because you are new? Would it be recommendable to first move there and get to know people and then establish your practice?

 

[cooldreams]

THANKS for the info. about the book! It sounds like good reading.

I am just wondering for those interested in rural medicine-- how do you establish yourself in a rural area/small town if you haven't lived there and are new there? Wouldn't the people have some kind of wariness because you are new? Would it be recommendable to first move there and get to know people and then establish your practice?[/QUOTE]

i have been wondering that myself. i think that since they are so badly needed, that if you build it they will come... 🙂

of course it may not be a lot at first, but the first few will be daring and if you are good, they will tell everyone else, and then you have no worries.

at least that is what im hoping 🙂

 

[raptor5]

I am just wondering for those interested in rural medicine-- how do you establish yourself in a rural area/small town if you haven't lived there and are new there? Wouldn't the people have some kind of wariness because you are new? Would it be recommendable to first move there and get to know people and then establish your practice?

Couldn't you do a residency at a rural program then hang a shingle somewhere within reasonable distance from that hospital. You know the specialists, the sytem, and have a good feel for the area, community and its needs. That way you not blindly throwing a dart at a map looking for a rural area. Just an idea.

 

[Peeshee]

Couldn't you do a residency at a rural program then hang a shingle somewhere within reasonable distance from that hospital. You know the specialists, the sytem, and have a good feel for the area, community and its needs. That way you not blindly throwing a dart at a map looking for a rural area. Just an idea.

Yeah, that sounds like a plausible idea. I also guess word of mouth works pretty well in small towns, as someone already mentioned. So,it's probably not much to worry about.

 

[lowbudget]

Interesting articles regarding this subject

City mouse, country mouse
http://www.cfpc.ca/cfp/2003/Mar/vol49-mar-editorials-1.asp

City vs. country: No practice envy here
http://www.ama-assn.org/amednews/2002/09/09/prl20909.htm

 

[Geronimo]

I spoke with a hospital were I grew up and they offered to "guarantee" me a salary for my first 12 months in return for coming to their community. It would be worth checking into for those of you heading to rural areas. I may take them up on it. They basically pay your expenses until you build enough patient base. So for instance, when your practice is bringing in less than $10K a month plus expenses, they bridge the gap. When the practice begins bringing in more than $10K a month plus expenses, you give the hospital back the extra until that 12th month and then you are free and clear on your own. Good idea or bad idea? To me, it sounds pretty good.