My passion and purpose is to get more docs to rural areas and keep them there. One of the most difficult challenges is working with local health systems. I keep in mind that all must work together for the benefit of patients, community, and physicians. If you are a community-responsive physician, then you have accepted challenge and the rewards will be great, although not monetary. About the Site and Author This is what I follow as guiding words on the subject:

Building a community-responsive rural practice is endless work, a job that inevitably becomes as frustrating as it is rewarding. It requires a large tolerance for uncertainty and willingness to risk. One must deal effectively and tactfully with a variety of constituencies, any one of which can enhance or threaten the success of the venture. These include community people - supporters and opponents - local physicians, government officials, a hospital, one or more funding sources, a new staff and, of course, patients and their families. Not everyone is enthusiastic for the new practice or empathetic with its leaders- who are at all times expected to maintain their own idealism, energy, and optimism. New rural health centers are fragile entities, both economically and politically. When they finally succeed in becoming established it is usually because their people-leaders, staff, board members-were as stubbornly determined as they were resourceful. Donald L. Madison, 1980 Service Orientation      Madison

My first point is to get docs, hospitals, centers, clinics, practitioners, providers, etc. to all attempt to work together. Rural health systems are too fragile and irreplaceable. In many ways rural health would be better off if all of the policies were governed by "first do no harm" or the endangered species acts with docs and hospitals as the endangered species.  Building a Rural Practice - Article in JRH

I may not agree with all that associations do (ask me about NHSC, J1Visa, or other short term fixes Obligations and the Potential for Indifference and Increased Health Costs  ), but I do know that we need to get more dollars into rural communities and keep them there as much as possible. This is something that every rural community and every rural citizen (including docs) should be for unless it causes more expenditures and other costs that the new sources are worth (temporary docs, massive unanticipated needs for social or sewage or education resources). John McKnight's work about community as well as studies by John Allen and others document the key elements of getting and keeping dollars and jobs and services in any community. Programs do not care, people care, but there are some temporary fixes that I am willing to accept as long as the community gets dollars or some form of help.   Community Driven Approach

While it is true that I may not know those on the list well, this is a common problem with all list serves. Although I may not be in rural practice now, I have been a solo rural doc and I do know rural Nebraska. Half of our 93 counties have 1 - 4 docs, a hospital, and less than 10,000 people. SMALL RURAL HEALTH SYSTEMS BY STATE We are second only to Texas and tied with Kansas in this number of counties involved. In these counties, the docs, the hospitals, and the communities are on the edge of viability regarding access, economics, and diversity of health services. Nebraska also has the lowest Medicare reimbursements in the nation. As a result of some of these challenges it is no surprise that we have over 60 rural health clinics and lead the nation in critical access hospitals. In the rural health clinic situation, we were slow to respond. In the critical access we spread the word fast. Because we have had rural docs in leadership positions in the med school, as well as visionary folks working out in the field with and for rural docs, we are doing a good job at getting and keeping rural docs in the state, especially in times such as this. Not only do the various people and groups need to work together at the local level, working together is important at the state level, and at the national level.

I am asking for some degree of trust in who I am and what experiences I have had. My somewhat shaky academic job (clinical times are here) has previously given me the time to study rural practices, admissions, and rural program models. Grants have given me the opportunity to study rural practices, rural faculty, and to work with rural doctor and hospital networks. I did not know about these things during my time in practice, and some doctors (even on this list) may not know about these now. I also know that doctors hear nearly all the bad things and very few of the things that work. Such is the nature of anecdotal medicine and the so-called "journals" of practice management that do little but spread fear and keep doctors thinking the grass is greener somewhere else.  Mobility and Turnover can be costly

Admission committees fail to select students that are likely to return to rural communities. In most rural states we need only a few rural docs a year admitted. Studies in Georgia demonstrate that medical school admissions can basically cut off the supply of rural docs (Basco). Each loss is 1 million per doc per year in economic impact.

By the numbers: Rural Doctors and Rural Economies

Rural Docs in Practice

Admissions Package

Restoration of Communities, Nations, People: Role of Rural Family Docs