Firms like LocumTenens.com do at least 60 percent of their business in rural America, where Health Professional Shortage Areas outnumber those in major metropolitan areas by more than 2-to-1 (2,157 to 910, respectively). Access to rural mental healthcare is even more restricted, with approximately 90 percent of almost 1,700 Mental Health Professional Shortage Areas located in rural areas.
The Center for Studying Health System Change indicates that rural Americans have access to significantly fewer physicians than their urban counterparts. For example, there are roughly 1.5 times more primary-care physicians (internists, family practitioners and pediatricians) per 100,000 people in metropolitan areas than there are in rural areas (78 versus 53, respectively). And the balance for specialists is even less proportionate. There are almost 2.5 times more specialists per 100,000 metropolitan Americans than per 100,000 rural Americans (134 versus 54, respectively).
In a world--and a healthcare industry--of increasing specialization, it's safe to predict that these disparities will continue to grow over the next few decades. Because there is a less-dense population to serve in rural America, it makes sense that more generalists and fewer specialists will locate there. This partially explains the common perception that rural doctors earn less than their urban colleagues, since generalists' compensation generally lags behind that of specialists.
Countering myths about rural medicine
There are other conditions that draw physicians to, or repel physicians from, one setting or the other. In a presentation to rural medical students in Nebraska, Robert Boyer, MD, a now-retired family practitioner, illuminated several "myths" that, he believes, keep many family physicians from choosing to practice rural medicine.
Myth #1: You won't make much money. Data from several sources indicate that rural physician incomes don't differ significantly from those of metropolitan-area physicians. Further, because housing, labor and many other products and services cost less outside of major urban centers, rural doctors generally enjoy a lifestyle of greater affluence.
A study published by the Center for Studying Health System Change in January 2005 indicated that, "After accounting for the local cost of living, rural physician incomes on average provide about 13 percent more purchasing power than urban physician incomes."
Moreover, based on responses from more than 2,400 physicians from a variety of specialties, LocumTenens.com's 2007 Survey on Physician Compensation and Satisfaction indicates that the average rural physician salary is about $7,300 higher than the average metropolitan salary ($241,690 in rural areas versus $234,400 in metro areas). And according to LocumTenens.com's 2007 survey on practicing medicine in rural America, nearly 800 U.S. physician respondents with rural healthcare experience indicated that rural profitability is about the same as (35 percent), or more profitable than (23 percent) urban or suburban practice. Another 14 percent said that, "The greater purchasing power in a rural community compensates for the lower profitability of rural practice."
Add to these statistics the growing number of financial incentives being offered by federal, state and local levels of government to physicians who are willing to commit--for a certain number of years, at least--to rural practice and the economic arguments against rural medicine just don't hold water.
Myth #2: You'll be on call 24 hours a day, 7 days a week (so you won't have time for yourself or your family). Boyer's experience was that if a rural physician learns to set proper boundaries regarding his or her practice, the physician actually ends up with more time for nonprofessional pursuits.
LocumTenens.com survey results indicate Boyer was probably right. Among almost 800 physicians who had practiced medicine in rural areas, 61 percent said the pace of rural practice is slower, while another 31 percent said it was about the same as in urban or suburban practices. Eighty-four percent said that rural practice is about the same as (47 percent), or less frustrating than (37 percent), larger-city practice.
In addition, almost half of those physicians who had practiced rural medicine said that they either preferred rural life more (30 percent) or that life was about the same regardless of where they lived (16 percent).
Even with the possibility of a heavier call schedule, many rural doctors still enjoy more personal and family time because they aren't spending one to three hours each day getting to and from work.
Myth #3: You can't possibly know enough. (You'll be isolated and "in over your head" professionally.) The shortage of providers in rural areas often makes it easier for early-career professionals to get a job, set up private practice, advance in their careers, and "network" through statewide professional societies, according to a qualitative study highlighted in the December 2006 issue of the National Rural Health Association's Rural Roads magazine.
Many respondents to LocumTenens.com's survey agree. Here's what they had to say:
- "The connectedness between components of the care delivery system is closer and easier to navigate in rural areas."
- "Practicing in a rural area is more immediately gratifying. Many patients return, as do their friends and family members, and you build a relationship over time."
- "Medicine in rural practice is clinical medicine. In an urban setting it is defensive medicine."
- "As a radiologist, it has been much easier for me to meet and get to know the clinical referring docs in a rural area. The threat of litigation is, in general, much lower. Rural patients are more appreciative of good medical practice and service than more demanding city dwellers."
Facing lifestyle concerns
So what's not to like about practicing rural medicine? Industry observers note that today's physicians are more concerned about leading balanced lives than their predecessors were. Based on more than 600 physicians' responses regarding what they like and dislike most about rural medical practice, physicians fear being more isolated professionally with fewer resources and career options in rural practice. Personally they fear having less privacy and fewer entertainment options than they would in larger metropolitan areas.
Spousal influence also plays a role in physicians' decisions about where to practice. Career opportunities for spouses; good schools for growing families; and access to cultural attractions, plentiful shopping and other entertainment options factor heavily into many physicians' decision-making processes about where to practice.
Attracting physicians to rural medicine Physicians need more exposure to rural practice options and opportunities. Among more than 600 physicians who said they had no rural healthcare experience, 29 percent indicated they never had been offered a position in a rural area, 25 percent said they just never considered it, and 33 percent said they'd never found the right opportunity.
Here are four steps toward attracting more physicians to rural America and keeping them there:
- Rural communities must market the lifestyle advantages of rural medicine and offer creative benefits focused on making that lifestyle more attractive to physician recruits. The inherent advantages include:
- Slower pace of life
- Greater feeling of safety for self and family
- Less traffic and pollution
- Shorter commutes
- Equivalent or higher net income
- Lower housing costs
- Less competitive lifestyle
- Closer proximity to outdoor recreational opportunities
- Elevated status in community
- More medical schools need to develop 'rural practice tracks' in their curricula to expose students firsthand to rural medicine.
- Rural residents need to align themselves regarding the critical importance of maintaining healthcare services in their immediate areas.
- Financial incentives--some offered through the federal government--are critical.
David Roush is president and chief operations officer of LocumTenens.com, a physician recruiting firm.
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