Should Physicians Consider a Career in Rural Medicine?

A 2017 U.S News article saying that future doctors with an interest in rural health should consider a career in rural medicine.  They gave five reasons why it could be a potential draw:

1. Passion for Public Service

2. Rural / Outdoor Lifesyle

3. Patient Gratitude

4. Loan Repayment

5. Higher Salaries

The article seemed to be speaking to those interested in Primary Care, since they cited a variety of health problems the doctor might encounter, and noted that rural doctors might be the only, or one of only a few doctors in town who would be able to care for these problems.

The truth is that rural medicine is dying and the days of the solo town doctor are pretty much gone.  Most rural care happens in small hospitals across the country, which are closing by the hundreds as astronomical costs of regulations, lawsuits, insurance, low reimbursement and lack of patients. These concerns make it almost impossible to keep these small islands of care open without special Federal funding intervention.  It is next to impossible to recruit for many of the positions, especially in high litigation specialties like obstetrics, because there is little to no backup and bad outcomes can occur, despite the doctor’s best efforts, due to lack of equipment, medications, or blood products that would be readily available at a larger facility.  Call can also be a daunting 24/7 endeavour at many locations.

In addition, after spending most of their 20s, and sometimes 30s, in school and training most doctors are ready to settle down and start a family.  This means having employment or social activities for the significant other and good school districts for the children at the very least. In an era of Big Box Stores and fast food, it’s often hard to convince hardworking professionals to move to a location where the nearest mall shopping may be several hours away.  Many doctors also want to buy homes, but buying in an area that likely has a depressed housing market can be scary to potential recruits in case the job doesn’t work out.  

Finally, it’s disconcerting to put all of your eggs in one basket.  Rural hospitals are usually at least 30 minutes from another hospital of any size, by definition.  Some have distances counted in hours in Western half of the nation.  If the hospital closes down, or the job does not work out for other reasons, you could be stuck with a house that will likely not sell quickly, and no nearby hospital to transition to for work, forcing a move.All of that being said, rural medicine was the most enjoyable time I have had as a physician. The patients truly are grateful for your care, the cases really are interesting (if not downright terrifying at times), and the locations can be absolutely stunning.  Frankly, I agree that more doctors should give it a shot. You might just want to try by doing it as a Locum Tenens physician, first.

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Karyn Tapley MD

Dr. Karyn L Tapley, MD is a residency-trained Ob/Gyn with a fellowship in Integrative Medicine. She was born in Ft. Myers, Florida into a military family and spent the first few years of life living with her parents in Okinawa, Japan. After returning to the states, her father was recruited by Texas Instruments and the family moved to Houston where she spent most of her young life. She moved back to Florida in her early 20s and obtained a BS in Marine Biology from the University of West Florida, before moving on to the University of Florida for medical school. She obtained her residency at Christiana Health System in Delaware. This large, community hospital was situated on the I-95 corridor between Philadelphia and Washington, DC, providing ample educational opportunities with over 8000 deliveries a year and only 16 residents. After successfully completely residency, Dr. Tapley moved across the country to be closer to her husband who had been deployed to the West Coast. She joined a Gyn-only practice with Aesthetics in Oregon and was able to add an extensive cosmetic-surgery education to her skillset. From there, she transitioned to traditional Ob/Gyn care, as an employed physician, in northern Washington state so that she could be closer to her husband who was stationed there. Frustrated with the typical bureaucracy & politics of hospital-based care, she turned to rural Locum Tenens (“traveling doctor”) for a change of pace and to have some control over her life. For over 3 years, she traveled with her husband, now retired from the Navy, her 2 large dogs, and an Amazon parrot named “Cowboy” in a small, vintage travel trailer, caring for women and babies in rural towns from Bar Harbor, ME to Astoria, OR. Eventually, they were ready to return home and she opened her own women’s health clinic and medical spa in northern Washington state. It was during this time she obtained her fellowship in Integrative Medicine from the world-renowned Dr. Andrew Weil Center for Integrative Medicine at the University of Arizona in Tucson. Her non-clinical interests include real estate investing and financial planning for female physicians and other high-income female professionals. She has completed her real estate license training and is currently completing her master’s-level Certified Financial Planning course to sit for the CFP exam. She will be a guest speaker at a major non-clinical career conference in October, speaking on Locums opportunities. For fun, she races cars.