Richard Armstrong, MD, FACS, is a practicing general surgeon at Helen Newberry Hospital, a critical access hospital (CAH) in the upper peninsula of Michigan.
The United States is facing not only a shortage of physicians, but also a geographic distribution problem. Physicians prefer to settle in urban and suburban areas of the country for many reasons. In a poll of 2025 physician members of Sermo the top three obstacles to recruiting physicians to rural areas were:
- Lack of cultural and educational opportunities for families
- concerns about on-call coverage
- limitation of sub-specialty support
Respondents listed lower pay, limited work opportunities for spouses/significant others, and poorer technology, but these reasons were of much less concern.
The Graham Center for Policy Studies in Primary Care addressed this issue in June of 2013. Data from the 2007 census and the National Provider Identifier file documents the unequal distribution of primary care physicians in America.
Their data shows there are approximately 80 primary care physicians per 100,000 people in the United States; howeverthe average is 68 per 100,000 in rural areas and 84 per 100,000 in urban areas. They write that “New incentives and policies for distributing primary care physicians to areas of greatest need, as well as increasing the absolute number of these physicians will be needed to ensure access for the newly insured.” [Under current health care reform].
The Sermo poll resulted in a lively and constructive discussion among members of the community, many of them with long careers in rural medicine and surgery. Many of the respondents discussed the long hours and lack of adequate call coverage as obstacles to recruiting rural physicians. Possibly one of the most honest and constructive comment came from a rural surgeon from Missouri, who had this to add…
“Practicing for 30 years in rural MO, what impressed me the most with rural practice physicians, is that, if you really want a physician to work in a given area, YOU HAVE TO GROW HIM/HER YOURSELF. In other words, the physicians most likely to stay, and prosper, in rural areas, are those who grew up in a rural area, either where they are practicing, or very similar and close.
You simply cannot expect, in the main, for non-rural physicians to suddenly want to live the rural lifestyle. Those who grew up in rural lifestyle 1) are already used to the obstacles to cultural/educational opportunities (and have demonstrably overcome those obstacles on a personal level) and 2) know exactly what to expect, and how to blend into the community.”
As a fellow rural surgeon having relocated to upper Michigan from suburban Chicago over 30 years ago, I agree with this observation but there are other strategies that work as well. Rural practices can be more “friendly” to the physician-patient relationship and in many ways rural physicians can feel more appreciated by their patients. Doctors generally earn enough to be able to live in a rural location but travel to a more urban area for cultural events, shopping and dining and then return home to the relative peace of the country.
The information age, as demonstrated by the Sermo community, has gone a long way toward eliminating the relative isolation rural doctors once felt. Today, with unlimited on-line access to a multiplicity of specialists and medical information on the internet, there is no reason for a rural doctor to feel isolated.
As America works through health care reform, physician shortages, scope of practice issues and new practice models, rural areas need not be avoided by new graduates. Rather, they can offer exciting challenges for medical and surgical careers, and they can be part of a community which appreciates your expertise, caring and commitment to an honorable profession.
High quality medicine and surgery exists in many rural locations in America. After all, the Mayo brothers started out in the cornfields of southern Minnesota. Who can predict where the next Mayo clinic may arise?