Why is rural healthcare payed higher

[CaptainJackSparrow83]

---

Members don't see this ad.

Forgive me for being stupid but I always imagined rural healthcare was comprised of low income families for the most part, farmers, factory workers, and mostly blue collar jobs.

How exactly do they afford the medical bills?

Example : my uncle said his best friend from high school is an orthopedic surgeon in some rural area making 1.5 million when the average salary is typically 500-800 k.

 

[ERDOC555]

Supply and demand

When there are no doctors for miles, the insurance companies (payers) have no leverage in reimbursement negotiations. No one is going to buy an insurance plan with no covered family doctor, etc. so insurance companies are forced to pay the only FM doctor for miles quite a lot of money since they need them on their plan.

 

[wholeheartedly]

Forgive me for being stupid but I always imagined rural healthcare was comprised of low income families for the most part, farmers, factory workers, and mostly blue collar jobs.

How exactly do they afford the medical bills?

Example : my uncle said his best friend from high school is an orthopedic surgeon in some rural area making 1.5 million when the average salary is typically 500-800 k.

insurance.

you often have to offer more money as incentive to get some people to move to some of these places.

he might corner the market too. we have one ENT in a 100 mi radius in my hometown.

 

[Peach Newport]

A few things. Just off the top of my head.

1) underserved/rural doesn't necessarily mean low patient volume - in fact, it often means high patient volume, because you're the only game in a large area. (also, take note that "underserved" doesn't necessarily mean "rural." In fact, it often refers to low income urban areas).

2) in desirable areas, alot of the money that might go toward paying doctors is pocketed by administrators, and the corporation as profit. Since there are fewer doctors willing to practice in rural/underserved areas, they need to offer higher pay to attract them. They need to trim the fat, so to speak.

3) Not all specialties pay better in rural areas, and the ones that do often don't pay that much more. It often depends a lot upon that particular patient population.

 

[wholeheartedly]

also, rural doesn't always mean blue collar and/or poor. you can still have a range of jobs and incomes

 

[FrkyBgStok]

In addition, being the only doctor for miles can also mean more work which means more money. In some of the less rural areas around me, the family practice doc sees a schedule, works the ED, does the deliveries, sees their own hospital patients, does newborn nursery rounds, etc.

 

[Terry Toma]

I imagine that overhead costs are a part of the equation, too. If two practices are receiving the exact same reimbursements, the one that is paying Manhattan rent is going to have a whole lot less money left over for everything else than the rural Ohio practice. If medicine worked like other businesses, the Manhattan practice would just charge twice as much as the rural Ohio practice to pass along the higher overhead cost, but that kind of pricing power doesn't really exist in medicine, and making up for the difference with higher volume can only be taken so far.

 

[VincentAdultman]

I'm a rural orthopaedic surgeon. You guys keep flocking to the coasts. I'm just gonna chill.

 

[DPTinthemaking15]

Yup... What everyone else is saying. There is a local orthopedic surgeon that has no competition for 70 miles. Plus, just because it is a rural area, doesn't mean it is made of poor workers. I live in a town that has maybe 2300 people. Yeah, some are blue collar/poor, but most live decent lives. Also, the average salary where we live is around 50-60k and anything over 90k you are considered "living high on the hog." Like @Pompacil said, keep flocking to the coast lol.

Edit: As patient volumes go, we have another orthopedic surgeon that works 40-50 hours a week. In his words "I usually arrive at 7:00, leave by 12:00 and I'm at the gym by 12:15. Of course there are days I work longer, but I love my gym time."

 

[CaptainJackSparrow83]

I'm a rural orthopaedic surgeon. You guys keep flocking to the coasts. I'm just gonna chill.

Im not even a doctor yet but I will tell you there is a point where you realize your life style and location does in fact matter perhaps more than money
My father probably makes more than most parents combined on the thread but chooses to live in a 3 bedroom house in a metropolitan city on the west coast. Why? Weather, culture, opportunities outside of work.
Ive been going thru the whole dilemma of dropping out of med school to become a 100 k /year engineer in California. Cant say how happy I would be on the job but money wise I would be happy because most of my free time I would be at the malls, hiking trails, the beaches, or the other slightly distant attractions (tahoe, Yosemite , hollywood, universal studios, disney - lol, vegas).

To me a villa, bmw, rolex watches are to impress others, it doesnt bring me much happiness personally. But going out every weekend and going surfing, or hiking as mentioned, makes me infinitely happy.

 

[VincentAdultman]

Im not even a doctor yet but I will tell you there is a point where you realize your life style and location does in fact matter perhaps more than money
My father probably makes more than most parents combined on the thread but chooses to live in a 3 bedroom house in a metropolitan city on the west coast. Why? Weather, culture, opportunities outside of work.
Ive been going thru the whole dilemma of dropping out of med school to become a 100 k /year engineer in California. Cant say how happy I would be on the job but money wise I would be happy because most of my free time I would be at the malls, hiking trails, the beaches, or the other slightly distant attractions (tahoe, Yosemite , hollywood, universal studios, disney - lol, vegas).

To me a villa, bmw, rolex watches are to impress others, it doesnt bring me much happiness personally. But going out every weekend and going surfing, or hiking as mentioned, makes me infinitely happy.

No money is certainly not the end all be all and I don't want to imply that's why I'm happy where I am. I simply like living in the country more than the city.

 

[wholeheartedly]

Im not even a doctor yet but I will tell you there is a point where you realize your life style and location does in fact matter perhaps more than money
My father probably makes more than most parents combined on the thread but chooses to live in a 3 bedroom house in a metropolitan city on the west coast. Why? Weather, culture, opportunities outside of work.
Ive been going thru the whole dilemma of dropping out of med school to become a 100 k /year engineer in California. Cant say how happy I would be on the job but money wise I would be happy because most of my free time I would be at the malls, hiking trails, the beaches, or the other slightly distant attractions (tahoe, Yosemite , hollywood, universal studios, disney - lol, vegas).

To me a villa, bmw, rolex watches are to impress others, it doesnt bring me much happiness personally. But going out every weekend and going surfing, or hiking as mentioned, makes me infinitely happy.

Yeah, i'm not all about money and stuff. I prefer open spaces, fresh air, hiking, stars in the clear sky at night, no neighbors breathing down my neck, room for the dogs to roam, bonfires, and on and on. Lots of people make me claustrophobic lol.

 

[Donald Juan]

Im not even a doctor yet but I will tell you there is a point where you realize your life style and location does in fact matter perhaps more than money
My father probably makes more than most parents combined on the thread but chooses to live in a 3 bedroom house in a metropolitan city on the west coast. Why? Weather, culture, opportunities outside of work.
Ive been going thru the whole dilemma of dropping out of med school to become a 100 k /year engineer in California. Cant say how happy I would be on the job but money wise I would be happy because most of my free time I would be at the malls, hiking trails, the beaches, or the other slightly distant attractions (tahoe, Yosemite , hollywood, universal studios, disney - lol, vegas).

To me a villa, bmw, rolex watches are to impress others, it doesnt bring me much happiness personally. But going out every weekend and going surfing, or hiking as mentioned, makes me infinitely happy.

You make it sound like choosing to live in a smaller house in Cali is some unique thing. That's why property in those areas is sky high compared to the SE and midwest, and incomes for physicians is lower as more want to work there.

 

[CaptainJackSparrow83]

You make it sound like choosing to live in a smaller house in Cali is some unique thing. That's why property in those areas is sky high compared to the SE and midwest, and incomes for physicians is lower as more want to work there.

True point. I would prefer a 100 k job in primary care in the valley vs some 300 k job in a private practice in nebraska.
From most of my experiences, family friends they dream for big big homes. While my dad can afford it pretty easily its not his taste.
His philosophy is : I can only be in one room at a time
And for me, being somewhat close to nature while still being within the grasps of city luxuries is ideal. Lets just hope those fires dont eat me yeah ? aha

 

[Perrotfish]

True point. I would prefer a 100 k job in primary care in the valley vs some 300 k job in a private practice in nebraska.

There are exceptions to this rule, but keep in mind that your salary is usually a pretty good reflection of how much you are valued by your workplace. The 100K office is likely to treat you much worse, and expect much more of you, than the 300K office.

You will probably spend at least half of your waking hours at work. Its worth asking what your job will do to keep you happy. When are dealing with an incompetent MA or an abusive nurse, do they fix the problem or do you get to have a discussion about interpersonal issues? Do they bend over backwards to make sure you are adequately staffed? Do you share office space? Do you have enough rooms to work? How abusive does a patient need to be for you to fire them?

If you don't mind getting screamed at by 5 anti-vaccine crusaders/drug seekers/ whatever a morning, by all means take the 100K job. Otherwise go where they need to keep you.

 

[mistafab]

Thats sad bro.

Living in the city is like being forced to see people everywhere at all times of day. Morning jog? People everywhere. Picnic at the park? Hippies in drum circles. Going for a hike? School field trip or druggies asking for your loose change.

I want to get home from work - see my nice house on my four to ten acres, have my dog run up to me, and breathe the open air in the woods. Just my family and I in the world. Get to my workshop - just me and my leatherworking. A cold beer in my hand, and a little radio turned on. Only after my home gym workout.

*peaceful music plays*

True point. I would prefer a 100 k job in primary care in the valley vs some 300 k job in a private practice in nebraska.
From most of my experiences, family friends they dream for big big homes. While my dad can afford it pretty easily its not his taste.
His philosophy is : I can only be in one room at a time
And for me, being somewhat close to nature while still being within the grasps of city luxuries is ideal. Lets just hope those fires dont eat me yeah ? aha

 

[CaptainJackSparrow83]

Thats sad bro.

Living in the city is like being forced to see people everywhere at all times of day. Morning jog? People everywhere. Picnic at the park? Hippies in drum circles. Going for a hike? School field trip or druggies asking for your loose change.

I want to get home from work - see my nice house on my four to ten acres, have my dog run up to me, and breathe the open air in the woods. Just my family and I in the world. Get to my workshop - just me and my leatherworking. A cold beer in my hand, and a little radio turned on. Only after my home gym workout.

*peaceful music plays*

You do you, silicon valley can be pretty peaceful just 10 minutes out from the main city

 

[Precedexed Out]

Supply and demand. The beauty of the free market system. Rural pays more because the supply is usually lower. As we know, big cities have more supply so medical groups can get away with paying less. I did a rotation in a rural area a few months back that only had two OBGYNs and they were actively recruiting one to start in 2019. The physician recruiter told me he was going to be making big money because of the difficulty to get someone. This isn't near as difficult in the big city. Another interesting part is the spouse. Often times, as the recruiter told me, the physician doesn't mind going to a rural area, but the spouse doesn't want to for various reasons.

 

[CaptainJackSparrow83]

Question guys.
When people go to top tier med schools like harvard, stanford, ucsf, they usually end up at top notch residency programs
When people go to lower tier programs or even foreign schools they get community residencies.

Lets take only family medicine as an example.
Well then theres a high chance the UCSF family medicine resident stays in the city, and the foreign school/ community program resident stays in some rural town. Doesnt the rural doctor probably earn more money?

 

[AnatomyGrey12]

Doesnt the rural doctor probably earn more money?

Yes. What part of this is difficult to grasp? This is assuming the UCSF grad truly does stay in the city, and I wouldn't make that assumption.

 

[CaptainJackSparrow83]

Yes. What part of this is difficult to grasp? This is assuming the UCSF grad truly does stay in the city, and I wouldn't make that assumption.

So when is the UCSF grad rewarded for hard work? He probably worked his butt off in undergrad to get a killer MCAT, killer GPA, and killer app, meanwhile someone couldve just partied their way through college, got a Caribbean matchup or a low tier DO school, passed boards, and went to family medicine. End of the day they are both pretty much the same.

 

[radsisrad]

So when is the UCSF grad rewarded for hard work? He probably worked his butt off in undergrad to get a killer MCAT, killer GPA, and killer app, meanwhile someone couldve just partied their way through college, got a Caribbean matchup or a low tier DO school, passed boards, and went to family medicine. End of the day they are both pretty much the same.

Some people are more animated by status (e.g., IM attending at WashU or BIDMC) than by money, and that's all right - I can imagine why someone might take pleasure in knowing that (s)he works in a world-class hospital.

 

[CaptainJackSparrow83]

Some people are more animated by status (e.g., IM attending at WashU or BIDMC) than by money, and that's all right - I can imagine why someone might take pleasure in knowing that (s)he works in a world-class hospital.

So ultimately, post residency, where you went to school really doesnt matter besides self pride?
I can see the UCSF grad probably having a higher chance of matching into competitive specialties but if they both get the same specialty youre more or less the same?

 

[Frogger27]

So ultimately, post residency, where you went to school really doesnt matter besides self pride?
I can see the UCSF grad probably having a higher chance of matching into competitive specialties but if they both get the same specialty youre more or less the same?

Depends on what you want with your career. If you want to climb the academic ladder and chase prestige, then yes going UCSF --> HSS ortho will matter. Want to open up a cash only cosmetic practice in Beverley Hills? Stanford for plastics residency will probably help. However, that is not everyone's goal. If your goal is to make money then you will have ample opportunity regardless of where you did your residency.

 

[Scrubs101]

Y'all gotta stop spilling the beans on the true beauty of practicing outside of major cities, I can't enjoy my beautiful mountain/lake view on my few acres I bought for pennies on the dollar if all of a sudden people start flocking to these jobs

I kid i kid, but I'm definitely starting to put my eye on rural/semi-rural medicine

 

[Perrotfish]

So when is the UCSF grad rewarded for hard work? He probably worked his butt off in undergrad to get a killer MCAT, killer GPA, and killer app, meanwhile someone couldve just partied their way through college, got a Caribbean matchup or a low tier DO school, passed boards, and went to family medicine. End of the day they are both pretty much the same.

People from top schools overwhelming match into competitive, highly paid specialties like Ortho and Derm. People from lower tier schools almost all end up in lower paid specialties like Family, Pediatrics, and Psych. There is a huge difference in both compensation and quality of life between competitive and noncompetitive specialties that makes the difference between rural and urban medicine look pretty minor. That's the reward.

You are right that, for the handful of Hopkins grads who fir some reason decide to do a family residency and then who attach themselves to prestigious academic programs, they are likely to make less than their colleagues who were forced out I to private practice in the sticks. Of course, if they want the money associated with rural medicine the sticks would always be happy to have them. As many have pointed out, most people seem to prefer staying in the city even if it's at a lower price.

 

[VincentAdultman]

People from top schools overwhelming match into competitive, highly paid specialties like Ortho and Derm. People from lower tier schools almost all end up in lower paid specialties like Family, Pediatrics, and Psych

lol no

 

[Lexdiamondz]

So when is the UCSF grad rewarded for hard work? He probably worked his butt off in undergrad to get a killer MCAT, killer GPA, and killer app, meanwhile someone couldve just partied their way through college, got a Caribbean matchup or a low tier DO school, passed boards, and went to family medicine. End of the day they are both pretty much the same.

The UCSF Grad has opportunities to broaden their career in different ways - research, policy, academia, etc.

This actually perfectly illustrates why the race to get to a top-tier medical school is largely unnecessary for most graduates - most people just don't actually need the resources and opportunities they provide. If you want to be a leader in the field then yes, you really should be striving to go to the top-ranked schools because they have the resources and connections to allow you to do that. But if you just want to be an FM doc then there's no need for it - hell, many T-10 institutions don't even have dedicated primary care departments or residency programmes. For those of you not chasing big-time academic positions or research it doesn't matter at all.

 

[mistafab]

The rewards are innumerable. The 1 hour commute to work. The big drop in pay. The smaller house. The lighter wallet.

JK - truly it is a matter of the caliber of scientists you will work with. Being a leader of thought in your work. Having the money for projects and grants for your work/labs. And being able to mold/shape the field.

I've worked with lots of excellent doctors that went the academic/prestige route and what they get to do is just amazing. So if you are into that kind of thing then it can be rewarding.

So when is the UCSF grad rewarded for hard work? He probably worked his butt off in undergrad to get a killer MCAT, killer GPA, and killer app, meanwhile someone couldve just partied their way through college, got a Caribbean matchup or a low tier DO school, passed boards, and went to family medicine. End of the day they are both pretty much the same.

 

[IslandStyle808]

So when is the UCSF grad rewarded for hard work? He probably worked his butt off in undergrad to get a killer MCAT, killer GPA, and killer app, meanwhile someone couldve just partied their way through college, got a Caribbean matchup or a low tier DO school, passed boards, and went to family medicine. End of the day they are both pretty much the same.

And what about those caribs and DO students from new schools who had to work twice as hard to get half the opportunities the UCSF grad had. How in the heck is the UCSF grad not better off?

 

[CaptainJackSparrow83]

And what about those caribs and DO students from new schools who had to work twice as hard to get half the opportunities the UCSF grad had. How in the heck is the UCSF grad not better off?

The UCSF grad is better off but I think people are responding based on my given statement that they both are applying for family med (personally idk why anyone who worked their ass off to get into a school would want family med). I am too early in my education to say anything but I believe a DO student gets a family medicine pretty readily as long as he doesnt fiddle his nipples during clinicals yeah? The do student vs the UCSF student getting a competitive specialty is a whole different story though.

 

[AnatomyGrey12]

personally idk why anyone who worked their ass off to get into a school would want family med

Why are you in medical school?

 

[IslandStyle808]

The UCSF grad is better off but I think people are responding based on my given statement that they both are applying for family med (personally idk why anyone who worked their ass off to get into a school would want family med). I am too early in my education to say anything but I believe a DO student gets a family medicine pretty readily as long as he doesnt fiddle his nipples during clinicals yeah? The do student vs the UCSF student getting a competitive specialty is a whole different story though.

Well not just the better residency. It also better research in medical school, better connections, and most of all better program matching. Point being is that UCSF graduate has way more options.

In the physician job market, where you went for residency or fellowship has no bearing on salary (maybe getting the job, then again I'm not familiar with this subject). There was a doc that spoke at our school and he has stated a preference for community docs over academic docs when it comes to just doing the job. So the prestige can gives you options, but it doesn't equate to you being an all around better doctor than the one that came out of a community program.

 

[Lexdiamondz]

Well not just the better residency. It also better research in medical school, better connections, and most of all better program matching. Point being is that UCSF graduate has way more options.

In the physician job market, where you went for residency or fellowship has no bearing on salary (maybe getting the job, then again I'm not familiar with this subject). There was a doc that spoke at our school and he has stated a preference for community docs over academic docs when it comes to just doing the job. So the prestige can gives you options, but it doesn't equate to you being an all around better doctor than the one that came out of a community program.

Often "better" just comes down to fit and fitness for a job in a particular context. If I'm an employer in a rural hospital where the FM doc will be the only coverage for a large percentage of the time, obviously I'll prefer community grads whose residencies are more centred on producing "doers" rather than "thinkers". Conversely, many academic programmes prefer grads from other academic programmes because their focus is on research and teaching and advancing the field, not providing access.

 

[WingedOx]

So when is the UCSF grad rewarded for hard work? He probably worked his butt off in undergrad to get a killer MCAT, killer GPA, and killer app, meanwhile someone couldve just partied their way through college, got a Caribbean matchup or a low tier DO school, passed boards, and went to family medicine. End of the day they are both pretty much the same.

 

[KnuxNole]

So when is the UCSF grad rewarded for hard work? He probably worked his butt off in undergrad to get a killer MCAT, killer GPA, and killer app, meanwhile someone couldve just partied their way through college, got a Caribbean matchup or a low tier DO school, passed boards, and went to family medicine. End of the day they are both pretty much the same.

Well that UCSF guy IS rewarded for hard work by being a physician. I don't understand the problem...?

If he is making less money than someone in the country, he made the personal decision to CHOSE to work in a place with lower money. He can CHOOSE to work in a place that pays more.

It's a super easy concept to grasp broski

 

[KnuxNole]

Thats sad bro.

Living in the city is like being forced to see people everywhere at all times of day. Morning jog? People everywhere. Picnic at the park? Hippies in drum circles. Going for a hike? School field trip or druggies asking for your loose change.

I want to get home from work - see my nice house on my four to ten acres, have my dog run up to me, and breathe the open air in the woods. Just my family and I in the world. Get to my workshop - just me and my leatherworking. A cold beer in my hand, and a little radio turned on. Only after my home gym workout.

*peaceful music plays*

I feel ya. Sometimes big cities are just way too crowded. Lots and lots of beggars, and few quiet spaces.

 

[deomnibusdubitandum]

works the ED

As a family doctor you can work in the emergency room?

 

[Lexdiamondz]

As a family doctor you can work in the emergency room?

EDs in more desirable areas tend to not hire FM trained docs, especially recent grads. Critical access hospitals & hospitals which generally struggle to attract EM-trained physicians are generally much more amenable to hiring IM and FM trained physicians.

People forget that a good chunk of EM isn't done by ER docs. Obviously we're much, much more suited for the job but you can end up working in the ER as an IM or FM boarded physician.

 

[IslandStyle808]

Well that UCSF guy IS rewarded for hard work by being a physician. I don't understand the problem...?

If he is making less money than someone in the country, he made the personal decision to CHOSE to work in a place with lower money. He can CHOOSE to work in a place that pays more.

It's a super easy concept to grasp broski

Yes, this right here. At the end of the day the UCSF person had more options, and chose to be in a better location with lower pay. The reward for going to UCSF and working his or her tail off is not the "pay" but the "greater options."

 

[VincentAdultman]

Since so many patients abuse the ED because they have medicaid or no insurance, much of emergency medicine has nothing to do with emergent or urgent care. Another reason to stay away from single payer healthcare. Image how many services will be entirely wasted. A bunch.

Making a new handle after getting banned is a pretty bad look.

 

[WingedOx]

Making a new handle after getting banned is a pretty bad look.

It's pretty bad when the mods go for the full delete. I've only seen a couple of those.

 

[WisNeuro]

It's pretty bad when the mods go for the full delete. I've only seen a couple of those.

Should we still expect a chorus of people to start complaining about censorship and the mods violating their 1st amendment rights, of which they don't really understand the definition of?

P.S. Go Lions, let's get that wildcard!

 

[WingedOx]

Should we still expect a chorus of people to start complaining about censorship and the mods violating their 1st amendment rights, of which they don't really understand the definition of?

P.S. Go Lions, let's get that wildcard!

Usually they go full-delete when people are trying to hawk products or services and not just being a repeated troll. That "DoctorPremed" kid who was selling an admissions consulting service (he was a second year DO student who got in on his second try) was my ultimate example.

And there's no way an NFC North team is grabbing a wild card spot this season. The North is 0-5 against the South already this season.

 

[WisNeuro]

And there's no way an NFC North team is grabbing a wild card spot this season. The North is 0-5 against the South already this season.

Well....yeah. But I like to at least get to the halfway point in the season before my delusions fade and reality sets in for me as a Detroit sports fan.

 

[Winged Scapula]

Usually they go full-delete when people are trying to hawk products or services and not just being a repeated troll. That "DoctorPremed" kid who was selling an admissions consulting service (he was a second year DO student who got in on his second try) was my ultimate example.

And there's no way an NFC North team is grabbing a wild card spot this season. The North is 0-5 against the South already this season.

We are trying out a new policy of deleting post by trolls because leaving them up only encourages the type of person who relishes the presumed infamy.

 

[VincentAdultman]

We are trying out a new policy of deleting post by trolls because leaving them up only encourages the type of person who relishes the presumed infamy.

The I probably shouldn't have quoted him. Whoops.

 

[Winged Scapula]

The I probably shouldn't have quoted him. Whoops.

No worries.

But once you understand the psychology of people who troll the Internet you understand that they get off on having their "words of wisdom" be available for everyone to see even if they are no longer on the site.

I'm actually a fan of quoting posts simply because a lot of people like to go back and delete or edit them so provide some context to the discussion if that happens.

 

[VincentAdultman]

I'm actually a fan of quoting posts simply because a lot of people like to go back and delete or edit them so provide some context to the discussion if that happens.

I like it because it puts certain people's silliness on display. The internet is forever.