HealthMay 07, 2020

Is residency at an urban hospital right for you?

By: Brian Wu, MD, PhD

If you’re at the point in your medical education where you’re deciding on a residency, you might be feeling overwhelmed by the number of factors you need to take into consideration. One factor that often gets overlooked is the location of the program, for example whether it’s urban or rural. But finding a location that’s compatible with your personality and values and supports your quality of life is more important than you might think.

If you’re thinking about a residency at an urban hospital, take the time to understand the benefits as well as the drawbacks of this environment.

Advantages of working in an urban hospital

Working in a city hospital certainly comes with perks. Here are a few.

Increased job security and opportunity

Doximity’s US Physician Employment Report 2019, which outlines workforce trends across the medical profession, found a 5% increase in demand for doctors across the nation’s top 10 metropolitan areas, particularly in the fields of family, internal and emergency medicine as well as psychiatry and obstetrics/gynecology. Beyond the potential for better job security, this demand can also provide you with opportunities to gain experience which might not be as available in a more rural setting. This might be especially appealing to you as a doctor just beginning your career.

Opportunities to make important contributions in a wide variety of medical specialties also abound in bigger cities. University of Florida Health notes that teaching hospitals, most of which are located in larger urban areas, in particular offer a culture of medical learning and innovation, often including complex surgeries and cancer care.

Teaching hospitals also offer residents the opportunity to gain important clinical experience with the latest research and cutting-edge technology. Four of the five top-ranking hospitals from the 2019-2020 U.S. News and World Report survey—New York, Baltimore, Boston and Cleveland—were in major urban areas.

A healthier and more affluent population

Although differences are not dramatic, it’s true that as a doctor in a city hospital, you will be more likely to work with patients who are consistently in a better financial position than their rural counterparts and are therefore not as likely to be unemployed and/or uninsured for significant periods of time.

According to the University of North Carolina’s Rural Health Snapshot 2017, Americans living in urban settings have:

  • A higher average household income than rural Americans ($58,229 vs. $43,616)
  • A higher rate of postsecondary education (64.9% vs. 53.7%)
  • Lower rates of suicide (14.7% vs. 15.6%)
  • Lower rates of unhealthy lifestyle choices such as physical inactivity (22.3% v. 27.8%) and insufficient sleep (33.4% versus 34.3%)

These social determinants of health will shape some of the challenges you will—or won’t—face as an urban physician. For example, higher levels of education may translate to higher levels of health literacy, and higher levels of wealth might mean your patients are better able to follow care plans without having to make financial compromises.

Cultural and lifestyle opportunities

Cultural and lifestyle opportunities are important factors when you’re deciding where to apply for your residency. More and more students are attracted to urban areas for these very reasons, and some of the difficulties in recruiting and retaining rural doctors stem from the relative absence of amenities like recreational areas that make for a better quality of life. This is likely one of the reasons why only 11% of physicians practice in rural areas, as Medscape notes.

A residency in an urban hospital brings with it some amazing perks. Living in Los Angeles, I have enjoyed not only the weather and the nearness of the beach and ocean but also the cultural opportunities like museums and art galleries and the wide variety of restaurants. It was the promise of this lifestyle that first drew me to the city when I was choosing my own residency.

Disadvantages of working in an urban hospital

Before you sign up for this kind of residency, however, it’s important to be aware that this environment is not for everyone.

Urban health challenges

While urban patients may be healthier than their rural counterparts on average, this population comes with some unique health and environmental challenges as well.

According to a 2018 survey by the Pew Research Center, people in urban areas are more likely than their rural counterparts to cite drug addiction (50% vs. 46%), affordable housing issues (52% vs. 36%), crime (35% vs. 20%) and traffic (36% vs. 13%) as problems in their communities. All of these issues can affect the health of the patient population you’ll be working with.

Cost of living

While the New England Journal of Medicine reports that salary differences between urban and rural areas are negligible, the cost of living tends to be higher in cities. Of course, however, this can range considerably, even from one urban area to another, and some cities are more affordable to live in than others.

There are many helpful sites, such as the 2020 Cost of Living Calculator, that can help you calculate the costs of a certain urban area so that you can make a good financial decision when you’re choosing which residencies to apply to. Don’t forget that loan forgiveness may also be an option if you’re working in a rural area, though it may not be available if you choose a residency program in a bigger city.

In short, there are a wide variety of factors—economic, educational, emotional—that you should take into consideration before choosing an urban residency. Ultimately, though, because of the time commitment that a residency entails, it’s important to choose a setting that’s best for the kind of lifestyle that you want to lead and that will be a good fit as you enter one of the most important phases of your medical career.

Brian Wu, MD, PhD
Lippincott® Medicine
Lippincott is a leading international medical publisher of professional health information for practitioners, faculty, residents, students, and healthcare institutions with a full suite of essential medical products, from books and journals to digital solutions.
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