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Physicians Offer Insights on Practicing Rural Medicine

David Roush, for HealthLeaders Media, April 2, 2008
Ask the average physician and you'll likely find that he didn't go into medicine for the money. Despite fairly universal frustration with the contemporary constraints of practicing medicine, today's physicians profess motivations similar to those of their predecessors: the desire to serve, a fascination with medical science, or an attraction to the intellectual and social stimulation medical practice offers.

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.

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