Robert C. Bowman, M.D. email any time about this area to rbowman@unmc.edu
Links are below if you have been here before.
Intended for those in family practice residencies and others considering rural practice. This is not intended to discourage. It is to help you evaluate yourself and the community where you hope to practice. This should help you get a clearer picture of what you visualized for yourself for the next few years or a lifetime. Because many interested in rural practice are hoping to indeed, choose for a lifetime, it takes much serious thought and effort. Use your time wisely, moonlighting, vacations, recruitment fairs, visits to rural communities, rural faculty, etc. More about using your residency to prepare and other residency issues at Resident Issues and Answers.
For those interested in the next step, read and reflect on the following:
Physicians occupy an unusual spot in the social structure of rural communities. From an economic standpoint, they are successful entrepreneurs, well-paid business people similar to bankers and lawyers. On the other hand, they are also social servants like policemen or teachers, just as essential to the welfare and functioning of the community but paid for through a fee-for-service mechanism outside of local community control. This anomalous status requires some fairly innovative interpersonal and structural relationships to strike a workable balance. Rosenblatt and Moscovice, 1982
If you think you have what it takes to do this, then read on. It is possible not to be willing to adjust, but then again, you can refuse to grow in many areas. If you really don't want to adjust, then consider the following.
"The appalling cost to both the physician and to the rural community of this mismatch has not been well described. The young physician and his family moves to the town in good faith, making a long-term commitment. Within weeks or months it becomes apparent that the expectations of the doctor, and sometimes the town, are not to be realized. The agonizing decisions then begin whether to sever the relationship. For the rural community the trauma is almost as great: it is easier in most instances to be perennially without a physician than to find one, go through the process of change in adapting to a new one, lose the doctor and start the entire cycle over again." Tom Bruce, M.D. in Improving Rural Health
It costs several hundred thousand dollars to replace a primary care physician. You will never see this money, but the hospital and community will suffer this loss.
The spouse effect is a strong one:
"I think for the most part physicians who go to rural areas in the first place have already pretty well made up their mind that that is what suits them, small town living and so on. Once in awhile you may find somebody who is truly kind of an urban kind of person basically who tries it in a small town to see how they like it and of course it usually has to be a joint thing between the physician and his spouse and if you find that one side or the other isn't suited to small town living then it easily doesn't last. And so most of the people who go to small towns to practice in the first place have already, they are from that kind of a setting or they have already adapted to small town living and liked that kind of life style and so that part usually kind of solves itself."
If you are truly on a mission, then God or fate or whatever led you to this town will also take care of your family and spouse needs. If you are dragging someone with you, you better hope they can adjust or it may cost you or the town and likely both.
There are few things as rewarding as rural practice. There are few things as challenging in as many ways. Do what you can to prepare in a personal, practice, and family way.
Family Physicians Are Different why FP docs are indeed different, the importance of understanding this
Satisfaction of Rural Physicians 1995 survey results in Nebraska
Searching for a Rural practice safe sites to search, no overpaid recruiters with fees or phone calls
Adjusting to Rural Practice think ahead to what might happen, so you can choose well and prepare well
Self-Assessment of Local Recruitment Effort if your community does a poor job in this area, or a poor job in recruiting you, perhaps they will have trouble getting colleagues to help you in the future. Think about this as your review this checklist.
See Building a Practice for what it will take to be a part of the practice community
See Retaining Rural Docs for what it takes for a community to retain doctors
Community role for rural docs for what it takes to embrace the full range of rural practice
Rural Doctor Comments not that other doctors in urban communities don't complain, but here are some complaints in rural areas