Ask any medical student whether they’d like to become a small-town doctor, and the odds are slim you’d hear a “yes.” Just 1% of medical residents report wanting to live in a city with fewer than 25,000 people, according to physician staffing firm Merritt Hawkins.
That’s problematic for those regions. As interest in rural medicine wanes, it contributes to physician shortages and lasting health disparities, which is why rural practitioners have been called the unsung heroes of medicine, according to Medical Economics. And frankly, it’s why rural clinics are willing to pay more.
However, leaving metropolitan life requires a sacrifice that relatively few doctors are willing to make. Should you?
If you’re considering a move to small-town medicine, it could be one of the most meaningful experiences of your career. But depending on your situation, it could also be one of the hardest. Here’s what you should know.
The need for rural care
According to the National Rural Health Association, small towns have about 2,512 patients per primary care provider (PCP). In urban areas, it’s about 1,876 patients per PCP. The gaps widen considerably for specialists, especially for surgeons, as the New England Journal of Medicine (NEJM) notes.
Those disparities translate into deeper problems. About 26% of rural patients have missed out on needed care, NPR reports, and not just because of a lack of insurance. Access and scheduling also present barriers for small-town patients.
These are the same patients who disproportionately experience problems associated with chronic disease, mental disorders and unhealthy behaviors like smoking. Their health needs may be greater, yet their access to care is diminished.
While efforts to digitize care through telemedicine have helped connect more big-city doctors with rural patients, telehealth can’t serve everybody, especially since Pew research indicates that about a quarter of rural Americans lack reliable access to high-speed internet.
Instead, small towns need boots on the ground (or scrubs, if you will) to help.
The upside to rural practice
Apart from the opportunity to make an impact on patients’ lives, there’s more potential in rural practice than you might think.
For starters, rural providers tend to make up to 5 to 10% more than their urban counterparts, according to NEJM, presumably because small-town systems have to make their offers more competitive to attract urban expats. As part of that trend, some doctors have enjoyed student loan forgiveness and sign-on bonuses as large as $100,000 or more in exchange for joining smaller clinics. Plus, small-town doctors may find that their dollars stretch further in rural areas because of cheaper cost of living.
Other benefits may be less quantifiable but still important. Rural residents tend to enjoy less traffic, better air quality, less crime and potentially reduced stress thanks to a slower pace of life. Often, small-town residents report a stronger sense of belonging, too.
Important tradeoffs to consider
For all the pros of rural medicine, there are important tradeoffs to think about as well, and many of the same factors that keep patients in big cities keep doctors there, too.
For young providers, the absence of nightlife, peers or potential dating prospects can make it difficult to build a satisfying social life. For physicians with families, the lower quality of schools in more rural areas can make it hard to justify a move.
And for everyone, the lack of nearby access means that when doctors themselves or their family need care, it will likely be harder to get. In addition, the potential to advance your career may be limited, especially for specialists.
A snowball of lesser-known effects factor in, too. As one young physician who works in Ogallala, Nebraska, told NPR, he often runs into people in town who will ask for medical advice. It can be difficult to step away from the practice and have some anonymity.
Getting started as a small-town doctor
Intrigued with the idea of rural medicine? If you want to move to an area with greatest need, you’ve got options. The Health Resources & Services Administration (HRSA) has designated thousands of rural localities as Health Professional Shortage Areas due to disparities in primary, dental and/or mental health care.
To try out a locale first, consider reaching out to a staffing agency to find temporary placement as a locum tenens doctor. It can be a great way to test the waters of rural America before diving right in, as can serving as a volunteer for rural regions through an organization like the American Red Cross.
Outside of programs specific to medical schools, other opportunities to get involved in rural healthcare include the National Rural Health Association, which offers a Rural Health Fellows Program. The HSRA also offers a loan repayment program through the National Health Service Corps, which requires a two-year commitment to an area in greatest need.
But no matter which route you take, it’ll be needed. According to Kaiser Health News, there could be up to 25% fewer rural doctors than there are now by 2030, which begs the question: What will happen to their patients? Will you be their future doctor?