Are You Ready for the Country? Apparently Not

John Commins, for HealthLeaders Media , September 24, 2008

A new survey of new physicians provides more glum news for rural healthcare.

In their 15th annual query of newly minted doctors, Merritt, Hawkins & Associates, the Dallas-based recruiters, asked 290 physicians in their final year of training where they want to practice medicine, based on population size. Only 4% of the physicians said they wanted to hang a shingle in a town with a population of 25,000 or less. And 57% of the new physicians named “geographic location/lifestyle” as the biggest factor for determining where they would settle.

I suspect that MHA is close to spot on, in part, because the results they’re finding match what we’re hearing from rural hospitals.

It boils down to this: The vast majority of physicians don’t practice, don’t plan to practice—and don’t want to practice—in rural America.

They may have different reasons for why they don’t. Maybe they’re young and single and want the excitement, culture, and diversity of city life. Maybe they’re married with children and they’ve got concerns about the quality of schools or lifestyle and employment options for their spouses. Maybe they want the resources, specialties, and camaraderie that a large health system can provide.

Maybe they like Major League Baseball. Whatever. The bottom line is they aren’t coming to the country.

And that is a problem, because right now, 20% of Americans live in rural areas, while only 11% of physicians practice there. It’s not going to get any easier as the Baby Boomer generation ages and more physicians of that generation retire along with them, and fewer and fewer new physicians leave the city.

Part of the problem may be that most medical students and young physicians aren’t from rural areas. As a general rule, physicians settle either where they’re from or where they’ve trained. “If they grew up in a small town and they like that style of living they are going to be easier to recruit than someone who grew up in New York City or Atlanta,” says Terry Peeples, CEO of the 128-bed Jenny Stuart Medical Center in Hopkinsville, KY, about 65 miles northwest of Nashville. “If the city is what they’re used to, then the small town for them is Hicksville.”

Peeples says small towns have a lot to offer, if physicians are willing to notice. For one thing, the cost of living, particularly housing, is much lower. And there is the status. “You can call it a plus or a minus, but you get to know people in the community,” Peeples says. “You’re a public figure and physicians are still to a certain degree revered and looked up to in smaller communities.”

Kurt Mosley, a senior vice president of development at MHA, says the problem has become more pronounced with the closure of rural hospitals. He notes that rural America now has about 5,900 hospitals, down from about 8,000 rural hospitals in 1980.

“When we lost those hospitals we lost a lot of these rural residencies,” Mosley says. “That was a good hook, but a lot of these rural residencies have gone back to the major metropolitan areas. It wasn’t quite a death knell, but it didn’t help.”

Rural hospitals are also more reluctant to hire physician-employees, Mosley says, because of the greater downside risk if the new employee doesn’t work out. And that runs afoul of a growing trend among younger physicians, 22% of whom told MHA they wanted to be hospital employees.

Finally, Mosley says there appears to be some unease among new doctors about the diversity of services demanded from rural physicians, who may be asked to reattach severed thumbs, set bones, or provide complex stitching—areas that are the bailiwick of specialists in larger communities.

Mosley recalls speaking with a hospital CEO from the Dakotas who said they were offering physicians a $250,000 annual compensation package but still couldn’t find any takers.

“I asked him why they weren’t having any luck,” Mosley says. “He told me ‘This place isn’t the end of the world, but you can see it from here.’”

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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