A physician responds to a recent WSJ article on the difficulty of recruiting physician to practice in rural areas:
When a foreign medical graduate has the same access to opportunities across the country as a citizen would, there is no incentive for them to even consider an area like ours. What ends up happening is a snowball effect: We can’t staff our facilities, and those who are here burn out with no one to share the burden. They leave for bigger cities, better call coverage and a better lifestyle, even though it may come with less money.
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{ 8 comments }
clearly, they aren’t offering enough to make up for the fact that, unless you’re really REALLY into working out in the sticks, it can suck big time.
One myth is that docs don’t go to the sticks because they are all city boys. I grew up in the sticks, love the sticks, and hate the city. I tried practicing in the sticks–and will never do that again.
Expected to be everything to everyone and often for no pay. Expected to pick up and carry on after the big city clinic has drained people of their ability to pay. Always having people assume you are professionally questionable just because you are in the sticks. All the people mad at you because you won’t help them commit insurance fraud like ol’ Doc Stone did–and unlike the city you run into them all the time–still mad.
Meanwhile, a lot of the elective stuff you want to do still goes out of town because no matter where you are in America, an interstate highway can get you to a metro area in about an hour, which is how long it can take to commute across town in the city anyway. They won’t do it locally because small town hospitals are always incorrigible gossip mills, the law notwithstanding.
Nope, I’ll just stay in the city and mope for the country.
Maybe doctors don’t go to school for umpteen years only to be treated like I was (by a “rural” hospital) when I got out.
Visit the blog. It ain’t pretty.
That is also one problem that I have with a rural area and was one of the reasons that I got out. When there is only one hospital, to whatever degree you need a hospital to practice, you are at their mercy. In my 20 years, I have noted that docs get treated better by hospitals when there are more hospitals around.
anon 8:18,
Truer words were never spoken. Once your move your wife an kids to a certain locale, the hospital knows you are a captive audience. Ideally, a person just out of residency should join a 5-10 person private practice directly BETWEEN two hospitals of adequate caliber. Competition between those two hospitals will help you. You can share call with the other guys in the group such that you cover hospital A this week and hospital B next week. There is always the threat that you take all of your business to the other hospital. I have seen this done successfully for years by our local ENT group. They are both excellent physicians and have become excellent negotiators and businessman as a result of the nefarious hospital administraors.
Be warned, the hospital is not your friend. If they could suck out your marrow and use it to pay their bills, they would. The only reason they are nice to you at all is that you still bring them business.
b
There is sometimes a degree of fault on the physician’s side, as well. Many physicians do not try to negotiate better situations with employers. Either they’re desperate and don’t think they have any other options, or they’re just not willing to try, but even the most basic negotiation can help physicians get higher salaries in less desirable areas.
Of course, sometimes the employer is completely at fault because they’re a bad employer. That’s just unfortunate, but an increasing reality.
Every hospital administrator believes in his heart that the only thing that stands between him and an even bigger salary is uncooperative noncompliant doctors. I have watched one local hospital (with award winning administrators) go through 5 generations of staff doctors on one service, each time blaming the quality and profit problems on the doctors. They then convince a new collection of fresh meat of that story and they take the bait only to give up in frustration in a few years. They never accepted that the problem is not the doctors. Thank God I have stayed out of it!
The social pressures to conform to an expected role are very strong in a rural area. It takes a strong heart to be yourself there. The novel “Arrowsmith” still rings true.
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