Survey compares rural and urban/suburban physicians

Ben Cole, for HealthLeaders Media, January 23, 2008
The nation's current doctor shortage is most acute in rural America, and an aging U.S. population combined with an increased interest in "quality of life" issues will likely make the situation worse before it gets better, according to representatives from The physician recruitment firm recently surveyed doctors to better understand their perceptions of practicing medicine in rural America versus practicing in areas with populations of 50,000 or more.

The survey found that there may be fewer differences, at least clinically, between practicing in rural areas and urban ones than one might think.

"Most of the physicians were pretty pleased with how rural medical practices worked for them," says Tim Skinner, executive director of the National Rural Recruitment and Retention Network in La Crosse, WI. "There are a lot of plusses to the practice of rural medicine--and actually many of the rural practices have the same equipment, the same technology as suburban and urban practices do. Much of it is quite up-to-date."

Of those surveyed who have practiced in rural areas, for example, 31 percent said they think profitability among rural practices was about the same when compared with their urban counterparts, and 23 percent even said rural practices were more profitable. Only 18 percent said practicing in a rural setting was more frustrating than working in an urban facility, and 45 percent said urban and rural settings were "about the same" in regard to frustration.

There are, however, stark differences between the two--especially when it comes to connecting with patients. Of those surveyed who had practiced in rural areas, 52 percent said they think doctors have a closer relationships with patients in a rural practice, compared with 3 percent that said they think doctors have closer relationships with patients in an urban or suburban practice.

"What's different is you have a more personal connection," says Jim Stone, MD, who practices in Atlantic, IA. "Medicine has become a volume-based profession, and in an urban setting you have much less time to spend with patients."

The survey also gauged the physicians' thoughts on lifestyle comparisons between urban and rural settings. Predictably, the findings were all over the map--31 percent said they liked rural settings more, 19 percent said they preferred urban settings, and 15 percent said life was about the same.

Doctors say where one prefers to practice is simply a matter of the type of person they are and the lifestyle they are accustomed to. "I think it really has a lot to do with the physician's personality and also the desires of the physician's family," says James C. McLoughlin, MD, a surgeon who practices in Ogdensburg, NY. "Rural settings can be more attractive to physicians who are interested in control of lifestyle: no traffic, little pollution, first-name basis for many conversations, really getting to know the people in a community. For the physician who likes the anonymity of a big city, rural life would probably not be desirable; however, for someone who enjoys solitude and space, rural life can be attractive."

Because of this, Skinner says rural facilities need to look at a potential physician's background and interests when trying to recruit. "A physician who is going to go to a small, rural community in Wisconsin is probably going to be very interested in hunting and fishing, as opposed to the physician who is going to go to a desert area in Arizona and New Mexico who might be more interested in cultural artifacts, archeology, anthropology, and desert life," Skinner says. "You have to look at those preferences."

Smaller facilities should also take steps to show potential physicians that they will not be overwhelmed by being the only, or one of few, doctors in a community. McLoughlin suggests community and rural hospitals seek partnerships with larger city or teaching hospitals by becoming part of an extended telemedicine network. That way, physicians practicing in the rural location don't feel isolated from colleagues, McLoughlin says.

"When a 'tough case' comes into the hospital, the rural practitioner would have access for input from a larger department of physicians or possibly even from those practicing at an academic center," McLoughlin says. "Avoiding the isolation of 'now I'm stuck with this patient that I can't figure out' should be a major goal of any rural hospital trying to recruit physicians."

Perhaps the most telling finding from the survey was why physicians who had not practiced in a rural setting had never done so. The three top answers were: never found the right opportunity there (26 percent), never been offered a position there (23 percent), and never considered it (19 percent). Only 4 percent answered they never practiced in a rural setting because they did not want to work there.

"As a former physician recruiter, I thought it was stunning to see that only 4 percent of responding physicians with no rural practice experience said they didn't want to practice medicine in rural America," says Senior Vice President Pamela McKemie. "What we'd like rural hospital executives to 'get' from our survey results is that physicians from all types of environments are open to practicing rural medicine, but you've got to approach them about your opportunity before they can consider it."

This is another example of why rural facilities need to be a little more cognizant of making sure the invitation to practice isn't restricted to a small group of physicians who are born in rural areas, Skinner says.

"We really need to emphasize the connection between the community development piece and the medical staff development piece," Skinner says. "In a small town they have to put that together because lifestyle issues have a great deal to do with people either appreciating a smaller community or not."

Skinner says it is crucial that facilities not only promote satisfaction among staff working with patients and practices in rural facility, but also work with the community as a whole to help draw potential physicians. He suggests healthcare providers tout agencies and resources such as social and human services that can potentially support physician practices. Stipulating how close the nearest college is for potentially furthering the physician's education, developing a strong community-based Web site, and promoting available leisure activities in the area are all ways providers can work with the community to attract physicians.

"The smaller the town, the more important the community development piece is," Skinner says. "What they can do is they can really step up and say, 'This is what our schools offer, here are our recreational and cultural activities.' If the community piece is missing, they might pass on a rural practice even if they offer the physician and the physician's family everything that they need."

Ben Cole is associate editor with HealthLeaders Online News. He can be reached at
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