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 LocumTenens.com. 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 LocumTenens.com 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 LocumTenens.com 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."
Working within a competitive market, within an expensive media buying area, Abington (PA) Memorial Hospital found that they could finally commit resources for TV and needed a campaign that would resonate within the community and leave a lasting impression. "It's very noisy here so we were looking for a campaign that would break out of the norm," says Beth Ann Neil, director of public relations and marketing for Abington Memorial Hospital. To accomplish this, Abington began work with Devito/Verdi in New York City.
The TV spots that were created each focus on a different service line, and feature the friend or partner of a patient that was treated at Abington. What's truly unique is the emotional nature of each spot and the humorous twist it takes.
An example of this can be seen in the spot called 'the runner.' The spot starts with a woman running a race. The woman starts by saying that she is running the race in honor of her boyfriend who needed heart valve surgery a year ago. She continues by saying that his condition was so bad that the doctors at Abington had to operate on him for over five hours. However, just when the viewer is completely emotionally drawn to the spot, it takes a turn by saying that, "when it was over there wasn't anything more they could do. I wish he was running besides me right now. But he ran ahead a couple miles back and I haven't seen him since. Show-off."
That light-hearted turn on what was an expectedly bad conclusion to the patient story took a risk that ended with a positive result. "It was critical for us to deliver the message in a way that reaches people emotionally," says Neil. "We're doing what no one [else] is by making our advertising personal and emotional." Though the campaign is still running baseline research shows great recall, which is also a positive twist on measurable results.
Despite gloomy predictions for the nation's economy, analysts are reporting brighter days for the future of internet ad spending. This article from Forbes outlines three separate reports offering prognostications for online ad spending from a general perspective, another with a strictly local viewpoint and an examination of streaming media.
To stay ahead of the social networking curve in 2008, interactive marketers should put brand monitoring in place, focus on objectives over technologies, and go for speed over perfection in applications deployment, according to a report from Forrester Research analysts.
For its Truth campaign, the American Legacy Foundation is featuring cartoon characters and real actors singing a sarcastic song called the "Magical Amount," a reference to the level of nicotine needed to addict smokers without making them sick. Foundation officials said the use of the cartoon characters is a move both to refresh the now two-year-old Truth creative and to use the mix of live-action and computer-generated animation seen in other spots targeting a teen audience.
The pens on the reception desk at my doctor's office, which is part of a large Massachusetts health system, are emblazoned with logos. Ditto for the clipboard the receptionist uses to check me in, the educational posters in the waiting area, and the little rubber hammer the doctor uses to test my reflexes. Clocks, sticky notes, prescription pads, stress balls, mugs--all have prominent logos on them. But they aren't branded to the practice or even the health system (which has a very spiffy logo, in fact). No, these items are all branded to the pharmaceutical companies that want my doctor to prescribe their drugs to me.
On my last visit, while waiting to get my blood drawn, I sat in a make-shift waiting area that was crammed to the rafters with boxes of freebies from drug companies. This wasn't a sample closet--or even a sample walk-in closet--it was a sample studio apartment. And when they called me in to get my blood drawn, they handed me a squishy ball with--well, you know what was on the squishy ball.
I couldn't help but notice it and wonder why on earth my doctor would want or need all these silly and tacky items. Surely the cost of pens and sticky notes and mugs couldn't be that exorbitant, could it? Could it be worth the cost to her image? Worth the cost of my questioning whether she's looking out for me or the well-dressed drug company rep in the waiting room?
SMDC Health System in Duluth, MN, put a price on all of those freebies the drug companies handed out each year: $100,000. That's how much they decided it would take them to buy their own pens and whiteboards and a long list of other items. And SMDC's administrators decided that $100,000 was a fair price to pay for office supplies that don't scream drug companies can buy us off with cheap trinkets.
"This shows people we're not in the pharmaceutical companies' back pockets," Kenneth Irons, chief of community clinics for SMDC, told the Star-Tribune.
Many practices, hospitals, and health systems have already banned doctors from accepting free lunches and trips and other big ticket items that patients can't actually see. But the SMDC policy goes a step further, getting rid of the logo-packed perks that patients can't help but notice.
And kudos to them: In cleaning out all the drug company freebies, they also made sure that their own image remained untarnished.
Thinking of just saying no to drug company logos and other perks? Consider these sources: