Note: If you are not from a rural area, you might be asking this question. If you are from a rural area you might wonder why anyone would think the rural lifestyle lacked anything at all!
Dear all:
I'm a 2nd year medical student with a very romantic and impractical vision of the rural doc that I want to be. The issues brought out by the recruitment/retainment question are very interesting--and sobering. Like the other medical students on this email list, I would like to keep my head in the clouds--and hold on to my dream--but also keep my feet on the ground. I want to have the courage to change the things I can, the humility to accept the things I can't and the wisdom to know the difference. Forewarned is forearmed, etc, etc.
• What do you recommend to help prepare for the cultural isolation and other differences of moving to a rural area? Are there little things that can help change someone into a physician suited for rural practice, or is it just something one becomes by actually being one?
• What 4th year electives are "essential" to someone wanting to be a rural FP? There are so many things to choose from, and so little time...
• And the most important question of all, should I start withdrawing from cappuccino now, or quit cold-turkey in 5 years?
Thank you all for your help. Pastorally yours, Debbie
Debbie, Hold on to your dreams and don't give up cappucino. Reality is what you make it. I would suggest that you take two rural electives, one in a remote rural community and one with reasonable access to a large town or small city. There is need for FP's in both and you can find out through experience what setting fits you best. Dr Andy
Debbie, You might also just learn to make your own cappucino and/or switch to tea or plain coffee. being in a rural area may require some adjustments after the city and the major medical center, but many of the adjustments are positive. none of the people i know here have alarm systems on their houses and cars, UPS brings boxes to my office even though they are addressed to my home---because they know I am here during the days(!), and there is certainly no corporate dress code. We make a monthly or so run to the "city" an hour away to stock up on a few things, but even that trip is becoming less as most of the things that you might not find in the small town can be found and ordered on the internet. Starbucks delivers to my house. Dr Maureen
One prepares by learning good skills of self-care, i.e. On an airplane in an emergency, put your own oxygen mask on before helping your child. Some of these skills include being grounded in faith (having a purpose and strength greater than yourself), cultivating good social supports and developing interests outside of medicine, maintaining margin (Reference - Margin, by R Swenson) and self-directed learning. Oh, and become computer literate. We have a cappuccino machine and use it frequently! Dr. Randy
Debbie the only requirement for rural medicine is the enjoyment of living in a rural community. The second requirement is that your significant other enjoy living in a rural environment. It helps to get the training that will promote the confidence and wide array of skills a rural practitioner needs but there isn't a pre-set list. As a female physician you're going to fill a vital role in any rural community you decide to live in and the skills you will need will principally depend on your interests. It's easy to say OB and Peds, but there's nothing to say you couldn't be the town proceduralist. Probably more important than your 4th year electives is your residency location. I would definitely recommend a community based program and personally
There are some common difficult aspects to being a rural physician, but I can get a cafe latte in a town of 200 nowadays. Rural people are educated, they invest in the stock market, they travel and see the world. True they travel to see the horses in Spain or the llamas in Peru as well as the archeologic sites and you'll frequently find us admiring a really nice tractor rather than sports cars but overall you will be able to find interesting people wherever you go.
If you expect social isolation it will happen. You can be actively involved in your community be part of the school board, girl scouts, soccer program, etc. Many rural physicians also become farmers/ranchers which not only gives you non-medicine related activities but ties you into common problems and interests with your patients. Good luck with your training, and I hope that rural medicine continues to be your goal. Dr. Joe
Thanks for your enthusiasm and idealism! Please don't loose your dream just because we are having a nitty gritty discussion on the listserve about the struggles of the "country doctor". After all, many of us are still out here practicing, loving our communities, feeling validated by our daily lives and privileged by the opportunity to play such a pivotal role in the health and well being of our community. Its just that we have no other format to share our inner struggles with work, our need to balance family demands and work responsibilities, and our own personal development as individuals over time.
I have practiced in Alaska for 16 years. I took every other night call carrying 10-15 OB patients per month with my partner Cathy for six years. During that time I married, became a stepmom, and had two children. Our small office has always been family friendly, and has offered on-site daycare for all office employees since its existence. Our hospital is 14 miles away from our clinic, so deliveries during the day often breed chaos for the clinic schedule. The excellent OB nursing staff have always worked well with us to allow maximum communication between office and hospital, and our Obstetric back-up has pinch-hitted for us from time to time when emergency back-up at the hospital site was necessary. The emergency physicians work well with us to facilitate daytime admissions during clinic hours.
Our community has grown with our practice, and we now have 4 in our call pool and others in the community to share the burden. Cathy explored her personal interests and passions along the way, and has received national recognition as the AAFP Family Doctor of the Year for her role as an advocate for protection of children from abuse and neglect. I pursued my passion of teaching and helped to start the Alaska Family Practice Residency.
My children are happy, well adjusted, and frequently accompany me to the hospital where they stay in a non-patient care area and enjoy the added benefit of cable T.V. that is not available at home. I maintained my professional name when I married, and my children were given my husband's last name. At school, they have several classmates who are my patients or whom I delivered. Sometimes they choose to share the fact that their mother is a doctor, and sometimes they don't. Their father, a contractor, has often taken them with him to work activities as well.
I love my life, and feel very fortunate to have been able to realize my dream to become an Alaskan "bush doctor" in a way that allowed me to grow both professionally and personally. No, I do not do all things. I don't do C-sections, and the evolution of my practice has been less surgical assisting, less emergency care, less intensive care, but more continuity community based care over time. I do not live in the "bush" as it is defined in Alaska, that is completely off of the road system. Many of my colleagues in bush Alaska, however, can tell you how rewarding and challenging their bush Alaska practice is. It is not without struggles, which is why this type of list serve is so important for those out in remote settings.
I am currently getting my pilot's license, and have been participating in the development of a community health center 1 hour north where there is a great underserved need and limited resources. I hope to be able to fly soon for clinics, thus finally fulfilling my idea of being a "bush pilot", a mother and spouse, and a full service family physician. I think so far, I have been successful. I am at present only 15 years out of training.
What do I say to aspiring rural family doctors currently in training? Sometimes your dreams are played out in a different variation of how you expected them to happen. That doesn't mean they aren't achieved. Sometimes you have to prioritize when and how you want to achieve your goals, and realize that although most doctors train for a decade and don't start their career until 30, there is still a lot of time to reach your goals during your practice career.
In order to keep fresh and interested in one's profession, it is known that some form of career change or advancement occurs about every 5 to 7 years. That may mean that you stay in that remote rural practice setting and then move, or that you change how you practice in that setting. Or, your career may develop in reverse, where you achieve the financial stability and family stability to be able to go to a more remote practice setting after your first decade of practice.
Yes, there are challenges, disappointments, struggles with the role of the family doctor in a rural practice in the 21st century. After all, it takes work to get where you are going. That doesn't mean that it isn't worthwhile or achievable. We are lucky to have the resource of computerization and internet access to allow for communication amongst ourselves.
For my colleagues in rural practice, I think that most of us view and use this resource not as a sounding board for whining and complaining, but rather as an honest place where we can work on those areas of our lives that are difficult in order to create solutions and possibilities. We also believe enough in the solid foundation of rural family physicians as the core of community based practice that we are willing to fight for improvements within the medical system. Thanks for your continued efforts.
As to choosing what electives and residency programs to explore, keep a broad mind and stick to the basics. Yes, the research shows that obstetrics, orthopedics, behavioral science, procedural skills, emergency skills, leadership skills and organizational management are important priorities. But the setting in which you accomplish this is equally as important. Rural minded med students and residents require ongoing rural exposure in order to keep their dreams alive.
Good luck on your adventures, and remember, that dreams only become reality if you keep your eye on the goals and keep focusing on the dream. Dr. Barb
Wish I had more time to describe the experiences, data, and realities of over 30 years study. Saw and/or heard first hand my family's career in Family Medicine over the past century. Dr Mary started as a frontier physician in Spokane when the main street was still dirt. My father moved North of town and built an FPC with an operating room in it. My last fifteen years have been in the Midsouth with a particular emphasis on the advanced family medicine necessary for sustaining a rural family practice. There is a dynamic tension between immersion in a full service practice versus the incremental approach where the student slowly digests rotations with a compartmental emphasis[ie Ortho, ICU, community/not academic ED,cardiology...]. The full immersion can overwhelm some students who are not ready to climb the steep slope of graded responsibility in a rural practice. The rural or community ED with 10k-18k annual visits is an ideal pace where the student can gain a lot of hands on experience with mechanical procedures and read on the various illnesses which present. This was the initial step which led to development of an integrated rural training track in Tennessee. It remains as an outstanding example of a highly desirable student rotation with spots available in all dimensions of Family Medicine. Since it is highly sought after, spots are limited. But by all means you should visit with them in KC each year. There others around the country. Dr. Bill
Dear Debbie, My pearl of wisdom to add to the excellent responses you have received thus far is that flexibility is one of the keys to being a rural doc. If life has to be a certain way for one (e.g., no ER vs. have to have ER, OB vs no OB, certain percentage of your patients Medicare, teaching opportunities, cappucino vs coffee, etc.) then being a rural doctor is going to involve that many more challenges and/or frustrations for oneself than someone more flexible. I am slowly sculpting my practice to be the way I want it to be (for example, I am decreasing the amount of ER I do, increasing the amount of teaching I do, and moving to a hospital based practice instead of a clinic a few miles away from the hospital) and my satisfaction increases each year. However, I have far too many insurance plans that I have to accept right now, I can't hire the expertise I want in office staff, Internet access is slow, etc. We all like control over as much of our lives as possible but I have found rural living's opportunities and advantages outweigh its disadvantages. The other part of the key for me has also been a significant other that is flexible and enjoys the same benefits to rural living as I do. Dr. Diego
Concerning the tips for students who would like to become rural physicians, you need to ask yourself these seemingly simplistic questions. They are actually rather difficult. Then maybe re -ask you questions of those doctors doing what you want to do. Do not ask a rural doc in a town of 10,000 with a draw of 10,000 more that has shifted ER docs, if you want to be in a town of 2,000 with a draw of 5,000 that only has 2 docs for the area. They are drastically different lifestyles and practices, but they are both rural.
What is your definition of rural? Is it a town of 3,000 or 10,000 and up? Is it a town that is 20 miles from a large city or 100 miles from nowhere? This makes a difference in your practice, your lifestyle, your mental health, and your family's sanity. It affects how your patients will view you and your family. It affects how they will perceive your accessibility. Obviously there are positive and negative aspects to this. They may bake you your favorite cake on your birthday; yet the football coach may also show up on your doorstep with a player on Saturday am during your child's birthday party.
Do you want to do OB? Do you have back up? Do you want to do C-sections? Is there a group established or would you go solo? Is there a doctor in town that you can have a collegial relationship with or are they still in the rat race for the bucks? How involved do you want to be in your hospital, the EMS, the Volunteer Fire department and First Responders? What sort of call schedule is acceptable to you?
Small towns have many wonderful advantages and beautiful people. They need desperately need healthcare. This sounds very pessimistic from a very idealistic person, but please (and this is really hard to do) Realize that you cannot save your entire world, no matter how small or rural that world may be. CONTINUE to DREAM but Know your limits as well as your family's. Involve your family in your decisions for where and what kind of practice you want. You are all in it together and open communication is the key. Doctor's spouse Katie wife, mom, community activist,ob instructor, fill in RN, office mngr ( in that order)
Because you are starting out on this track early and are able to take full advantage of your remaining training, you should be able to fulfill your vision. Sober means watchful, aware. This comes from someone who wants to be prepared. Good choice of words. You should not be fearful. It is OK to be concerned about the changes, just as long as forewarned does not mean scared away. Regarding comments by rural doctors and rural educators: You should understand that medicine is a troubled profession right now. In my opinion this is because there are too few of people like you who wish to serve and make a difference. This is also the reason why we have so few rural doctors. Remember that contact with rural and FP doctors is a good thing, but it will likely be a different quality and amount than your contacts with residents and attendings on rotations. These folks will probably only show you their medical side. You will not hear much about their family or personal life or aspirations. When you go on family medicine and especially rural rotations, you will see it all, good stuff and dirty laundry. Remember that all doctors complain in private with each other and those they work with, you just see much more of it when doctors allow you more time and more ability to ask such questions. You will certainly get an ear full (or computer full) by being on list serves such as this.
If you continue to pray for discernment and the ability to manage time well, you have won the battle, regardless of your decision on a practice or location.
The real question regarding rural or underserved or overseas or solo or whatever challenging path you take is, are you truly committed to whatever the Lord has in store for you (as a Christian), or as a person who wants to make a difference in others lives. If you are single, will you trust that the Lord has a person in mind for you now or in the future that will share this decision or will you buy in to the typical thought patterns of your peers that the selection of potential spouses is fairly limited in rural areas? If you are married, are you making this decision and working on it together?
Currently we have a female resident who is in Nigeria now on a mission. She has tailored her training to rural practice for the past 4 years. She has negotiated and signed a contract with a small town to allow her to be away overseas for up to 3 months a year on mission trips. She has been moonlighting for several years, all the time storing up these experiences to add to her learning, leadership development, and eventual practice selection. She has remained open to all of these possibilities and even taught a 6th grade Sunday School class one year. She is single, hopes to find a spouse, but is willing to wait.
More regarding preparation: Free time: International missions, leadership in local volunteer organizations, start up an indigent clinic Tuesday nights! Start up a rural student interest group or take on a major project for them. Start up an international mission group - Service and leadership are key components of being a rural physician.
Elective time: Use it to master medicine, take on the most challenging and most learning electives. Choose electives where you take care of patients and make decisions.
My theory is that you master medicine first, then begin to move on to more complex problem solving by integrating medicine and psycho-social, and relationships and helping people have insight into their problems. Finally you move into working with the practice relationships (office, practice) and then community relationships. Rural family practice is about complex problem solving in multiple dimensions. If you continue to grow and develop and integrate your experiences and learning, you will not shy away from the most challenging patients and practices. The choice to major in medicine alone is to regress.
Believe it or not, this complex decision-making is fun stuff and what all physicians should be about, but most have chosen more limited options, with significantly poorer health outcomes. Why else would we allow 673 people to die in prescription drug errors in the past 5 weeks? Or 38,462 in smoking related deaths? (Philadelphia Inquirer via Akron Beacon Journal article on Daily Habits of most Americans more deadly than anthrax - also Flu-related 6,124; Auto 4,080; Alcohol 1835; Murders 1618; AIDS 1412; Anthrax 4). Oh and by the way, family physicians are in the front lines in the war against nearly all of these threats to our citizens.
For those interested in serving the underserved, it is important to master the first steps earlier, and then move on to the more challenging (and more rewarding) ones. Dr. Bob
Debbie, I would suggest a residency in a rural area, perhaps a rural training track. This is a good way to test the model, in a setting that is geared to training you to do "the right stuff" and that gives you a chance to live the life for a few years - to learn to love it and stay in that type of setting, or to sigh and move on to what seems more right for you. You will work with docs who are living your dream and you will find out what the reality of this is. The rural training tracks are one of family medicines best kept secrets, and worth exploring as you move toward residency.
Pick fourth year electives that you enjoy and that speak to your particular interests. A good rural residency program will prepare you, the fourth year electives will enable you to continue to enjoy those things you went into medicine to enjoy. There is not one particular thing that is "good" to take and none that are useless. Everything you learn will help you in some way. That said, I agree that an elective in a rural place is a good idea, but don't expect to learn in a month how it is to be part of a community and whether you like or don't like it.
You can get cappuccino anywhere - at the very least in your kitchen, but I can drive across Montana dodging antelope, deer and elk, and never miss a latte.
Most important - don't be afraid to go after your dream - don't worry that you might not like it, just do it and see. You don't have to stay if you don't, and you won't know what you missed if you don't try.
You know, this is a lot of questions to ask oneself especially about something you know nothing directly about yet. What is to be lost by giving it a try and seeing if you like it? Sometimes we can deprive ourselves of a remarkable opportunity or experience by over-analyzing – ‘should I do it, maybe so, but what about that, so maybe not’ – and end up with a sort of paralysis and default back to something known and safe. How are you going to know the answers to some of these for yourself (you can get others answers or opinions, but they are not uniquely yours.) I say, just go for it, and know that you are free to choose to stay, change, or leave once you know for yourself how it fits.
Dreams are (part of) what makes the world go ‘round, and what makes life fun, exciting and a constant exploration – at least for me. I have been remarkably successful in shaping reality to my dreams, and not vice versa. Dr Roxanne
To me, one of the most attractive aspects of family medicine is flexibility. It accommodates many different types of people. You can analyze the precise demographics of potential practice locations, or you can take the plunge--plug your nose, hold your breath, close your eyes and jump ("Feet First, First Time"). Those decision-making techniques vary along a continuous spectrum within each person (perhaps changing with age, marital status, financial burden) and among a group of people. At FM conferences, it's stimulating to hear from people who are often polar opposite personality-wise, but completely unified in their service and love for patients. The prospect of joining that group is what first got me excited about family medicine.
Thank you all for sharing the good, the bad and the ugly about rural FP. Not only does it relieve you to "vent" on the listserv, but we students learn so much from it. Please don't worry about frightening us by being frank. It's our job to remember that each experience is individual, and that we can permutate the variables to suit our own personalities, dreams and boundaries. And besides, if we cain't run with the big dogs, then we should stay on the porch ;)
With gratitude, wide eyes and open mind, Debbie S. MS-2
We will never know the answers to the most important questions. I don't know exactly why my son decided not to play basketball (6ft 7, athletic, dunks two handed, age 16) but at least part is that he decided not to accept the challenges of daily physical exertion, getting up on Saturday AM, dealing with authority and those who tell you what to do and you have to do it, regardless. It is a long road to success in athletics, but if you don't take the risk and the challenge, you will not reap the reward. He has made this choice and it will take him to a different pathway, not better or worse perhaps, but different.
Students have many choices during medical school and residency. Most lead them away from the more challenging roles for physicians. Some keep their dreams alive, some don't. Most came to medical school for different reasons other than rural practice. We do know that about 15% of medical students know their final career path. About 30% of rural interested senior medical students knew that they were going to be a rural doc before medical school. This alone notes a group that expects challenges and prepares for them.
Rural practicing is challenging beyond belief, and rewarding beyond belief. My best stories and friends are still from rural practice and it is a standard of service that I return to and revisit even 14 years later. This has most often made me disappointed in subsequent clinical situations.
Bob Boyer does the best rural talk that I have seen to deal with the best and point out the challenges and motivate people to aspire. He uses these stories to illustrate the high and low points of rural practice and finishes by noting that in rural practice his patients not only respect him, but he respects his patients and those he works with. He notes Taylor Caldwell's book Dear and Glorious Physician (about Luke the physician in the New Testament) and how he looks back on a life of accomplishment and meaning. Rural practice is a bit more of a two way street with mutual efforts, mutual respect, and shared accomplishments. These are difficult to measure, but the are important nonetheless. Perhaps we should sum up similar to how Bob ends his talk:
"I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I--
I took the one less traveled by,
And that has made all the difference."
-- Robert Frost "The Road Not Taken," Mountain Interval, 1916
As Bob Boyer, first AAFP Doctor of the year, states in his discussions with medical students interested in rural family practice,
"I may be naïve, but I still think that a career in rural family medicine offers the best opportunity for the best doctors to be at their very best and have fund doing it and find those moments where you too will be dear and glorious." Other Boyer quotes Best Quotes in RME
Thanks to all those submitting responses
RCB
Rural Lifestyle response to a resident 6/2002
The Question - Dr
Zavala,
Yours made an interesting and very attractive reading. However, I am sure Derek
and others interested in rural practice (including me) will like to hear what
life is outside of medicine in the rural area. Your scope of practice seems to
be very broad and comprehensive. Does that go with commensurate financial
return? With loans to pay and the soaring cost of getting life started, monetary
return has become a major part of decision making for young M.D considering
specialties and practice areas.
U.I. Felix. M.D Figuzi@aol.com
For a previous series of postings regarding rural life
outside of medical
practice see above text at
http://www.unmc.edu/Community/ruralmeded/model/medsch/student_dreams.htm
The above captures rural life transitions and expectations very well. It
was in response to a previous question by a student.
The rest of the statement is provocative and a bit cynical: Your scope of
practice seems to be very broad and comprehensive. Does that go with
commensurate financial return? With loans to pay and the soaring cost of
getting life started, monetary return has become a major part of decision
making for young M.D considering specialties and practice areas. U.I.
Felix. M.D
I will assume this is a provocative statement and not a personal view.
Since this is provocative....
For my first response, I would reference the first three words of Scott
Peck's The Road Less Traveled. These words are "Life is difficult." The
situation regarding rural practice in every nation is not as good as other
types of practices, but usually good enough to work out. As to the
injustice in the world, those who have not yet seen it and been affected by
it are not likely to consider rural practice now or in the near future,
until they are brought face to face with injustice and poverty, etc.
Life as a physician in rural and academic and underserved practice has
taught me not to expect "commensurate financial returns" for doing the
right things. Doing the right thing should be a major part of what drives
all physicians. With or without loans or soaring costs, monetary return
should almost never be a major part of the decision for rural practice.
Wealth is not a matter of income, it is a matter of how you spend the money
that you receive. If you want to live lavishly, rural practice is not a
good choice. Bob Boyer, in his classic talks on rural medicine to students
and residents, gave any in his audience who got into rural practice to make
money the chance to leave at the start of his talk. He said that he did not
want any such people to contaminate the room.
boyer's video at
http://www.unmc.edu/Community/ruralmeded/facil/research/authors/boyer_links_and_presentations.htm
Rural physicians that I have advised have settled for a broad range of salaries
and benefits. Some have been taken advantage of. This invariably cost us as a
nation several rural workforce years and made things worse for the town where
"small minded people" took advantage of a naive graduate.
Some have practiced in a way that was different that planned. Some did better
than expected. Some rural physicians have taken advantage of others. In many of
these cases the town would also have been better off without the physician.
All have had to make adjustments to practice, town, family, and hospital/health
system.
Clearly the slavery of todays debts is a major concern, but this debt should not
be beyond ability to pay. The worst impact of todays loans and debt, in my
opinion, is the attitude that it fosters in those with heavy debt. This attitude
has doctors feeling sorry for themselves in the least and trying to get even
with those who enslaved them in the worst case scenario. Most commonly it
manifests as a subconcious "no one cared for me, so why should I care so much
for others" Ending this slavery should be a major goal. The West Virginia
Partnerships is taking this on by having no tuition for students in their
pipeline for college or health professions training.
This attitude is by choice. No one forced doctors to do such things, but those
who harbor this attitude will make bad choices, choices that we will all suffer
for as physicians. A physician can choose to have a good attitude about service
and availability and completion of duty and access and learning and .....
Choose to care and serve and make a difference!
Again the choice of rural practice is fairly simple. There are students who
choose service as a top priority, and those who choose other factors. Those who
choose to serve become rural doctors and a few other similar careers. This is
not the only factor. There are some who desire to become rural
physicians, but cannot because of family or personal or other needs.
In a profession that tries to value informed consent, NHSC and other programs
violate informed consent. New medical students have no idea what they are
getting into. Careful selections help, but the resentment of a few is a terrible
thing for those around them in underserved communities.
Not all is in vain however, those doing NHSC who leave rural practice often go
to urban underserved locations. Perhaps the lesson there is that training in
underserved areas for a long term preceptorship or residency might actually
improve the numbers choosing underserved locations after
graduation.
Robert C. Bowman, M.D, Co-Chairman
Rural Medical Educators Group of the National Rural Health Association
UNMC Department of Family Medicine Director of Rural Health Education and
Research
983075 Nebraska Medical Center
Omaha, NE 68198-3075
(402) 559-8873 or fax at -8118
Email: rcbowman@atsu.edu
http://www.unmc.edu/Community/ruralmeded/
Iles here again from rural Iowa (the lowest Medicare reimbursement state in the US). I laugh when people tell me about no social life and indebtedness as reasons against going rural. We are 45 minutes away from a university auditorium which has shown CATS, La Traviata, Stomp, Phantom of the Opera and many others for less than I paid in KC when I was in school. It took 45 minutes to get downtown there, too. We have season tickets to the Chicago Lyric Opera - on the first floor - because the cost of living is so low here that we can splurge! I graduated in 1987 with $100,000 in debt. We retired that debt in less than five years out of residency by living nicely but not extravagantly. It can be done and not painfully. Dr Tom Grau, LaCrosse WI, gave our residency class a great tip - live your first three years out of residency cost-wise the way you lived it during residency. It definitely worked for us. As far as monetary rewards, yes, it does anger me that I personally make not one dime seeing Medicare patients and actually lose money on Medicaid. It angers me that our practice must pick and choose new patients based on insurance coverage. I am thrilled, however, that these two groups of patients are also angry about this and tell our representatives to fix it. I practice 3/4 time and make a very nice salary as well as being a share-holder in my practice. My children are going up in a community where lots of people know them and watch out for them. I can see how my arthritic patients are doing while out on the square shopping. I know when one of my patient's family members die or is arrested from the paper. I know when labor negotiations are going poorly at a local factory. It actually makes my job much easier. I grew up in KC and have practiced in towns of 75,000 - 100,000. This is a much better life.
"Lynette Iles" liles64@hotmail.com
1. Often rural areas can provide some loan repayment assistance, may be NHSC eligible etc.
2. Our experience from our residency is that the starting salary guarantee is a fair bit higher for more rural areas
3. That all said - it ain't all about money. My husband and I paid our student loans off over 20 years + a NHSC stint for me - still working on the house issue and the two kids in college and one finishing HS. My job rewards me in so many other ways every single day that are without monetary value. I also read letters and articles about physician burn out and depression, discouragement with the profession, second guessing professional choice, their job becoming a chore and so on. I recently responded with difficulty to a survey on academic and physician satisfaction, where the "best" choice seemed to be something like "my job is no worse than a year ago" and going on to "my job is getting so bad I want to die" - well maybe not that extreme - I had to write in my answers like "My job is better every year" "My job satisfaction has skyrocketed" and so on. They asked questions about clinical depression/suicidality at work - no answer like "I want to jump for joy some days when I realize how lucky I am to work here." Call me crazy, but I don't make a fortune, and don't need one either. Roxanne Fahrenwald MD RoxanneF@ycchd.org
DR. Felix,
When picking a rural site one must consider a couple of important life style issues. First, is your family ready for small town life including being in the fish bowl. The most important, professionally speaking, is in my mind ER work. Some towns have arranged some outside ER coverage, first call coverage with mid-levels, or other creative ways to help cover the ER. Our community, which has a relatively busy ER, covers the ER with just the local Docs. This at times is a pain but also adds to the diversity of our practices (not to mention the increase in our production). The next issue is your comfort level without back-up. For us the closest specialist is 65 miles away. While this is only one hour by ground, 23 minutes each way by helicopter, it might as well be around the world on many winter days. Sometimes the patient may need an emergent consult in the big city but without us they would not even make it there. The last issue is entertainment. How far to the nearest symphony, major league sporting event, or shopping mall, etc. Is a good CD, high school football game, or the local true value going to be enough. In my opinion nothing beats living in a community where the streets are safe, the hiking is out my back door, your name is DOC, and the deer ( moose and bear also) play. It is true in small towns you work hard but the lifestyle is worth it. "Jeff & Lynn Zavala" jz2lz2@imt.net
It is possible to practice rural medical a different way, such as solo with low overhead, part time, same day, etc. See Jerry Maguire Goes Medical
More importantly is focusing on the really special things about small towns, such as the bond between people, and how they sacrifice for one another or for the town. Rural life can indeed be a Vast and Endless Sea, for those willing to try it out and explore it fully.