Back to Objectives for Rural Programs and Curricula
IV. Learn about managing rural practices, understand local, state, and federal health systems - Editor: Robert Bowman
Curricular Dimensions: Processes and Relationships
Description:
Variety of rural modes of practice - Faculty involved in preparing rural curricula should emphasize the management of a variety of rural practices. Students or residents should compare group vs solo private practices, for self profit vs salaried nonprofit opportunities, small rural vs larger rural.
Integration of practice management in the curricula - Quality faculty development teaches rural preceptors to integrate practice management within the curricula of the rural rotation or experience. Students can see the effect of the practice management style and policies on the practice. They can visualize the types of personnel that they will need. They can see the relationships they will need to develop with peers, administrators, staff, and patients.
Mandated practice management projects - The best rural practice management requires residents to participate in preparation for rural practice. Some programs require residents to work as practice staff in the front office. Oklahoma mandates that its family practice residents undertake the preparation of a rural practice plan involving needs assessment, financial projections, a building, equipment, and a rural community. This seems like a lot of work but this exercise addresses a lack of confidence in one's ability to set up a practice. Once the plan is complete, a major step toward rural practice has been made.
Financial consultation for rural practice - During the rotation, the preceptor should outline the financial consultants available, including the bank, the CPA, the practice consultant, etc. Examples of use of these resources as consultants is a necessary part of rural preparation.
Faculty advisors during training - Faculty advisors who know rural practice are an important resource in the choice of a rural practice. Faculty know the resident's skills and basic orientation (profit or non-profit, practice work ethic, major weaknesses and strengths) and are in a good position to help the resident prepare for rural practice and work with consultants.
Few rural practice consultants are available to residents choosing rural practice. Most work with the public health or hospitals. Some hospitals and state agencies offer practice advice. Physicians should be aware that those who pay for the advice, get the loyalty of the consultant.
A key area of need is legal and accounting advice. A qualified health contract lawyer should be a part of the final decision and even the negotiation process. Faculty advisors can be a part of this also but are limited in the legal arena, the teaching relationship, and the lack of information about the practice site. A good accountant can help prepare the physician for the financial realities of life beyond residency as well as the demands of a private business. In these days of changing reimbursements and increasing paperwork a practice consultant is essential. Even a small mistake can cause major losses of revenue or crippling legal action.