Rural health care is in the national spotlight, so there’s no better time to separate facts from fiction as health professionals start job searches and careers. Too often new health professionals have limited exposure to rural practice, so let’s set the record straight.
Rural Comes in Many Flavors
In some cases, rural means practicing in an isolated community with physical distance from more populated areas. There are several rural “frontier” definitions, one state defines it as population density that is eleven or fewer people per square mile. But in many communities, rural cities or counties are more densely populated and may be no more than thirty minutes from a larger city. Be sure to do your homework when presented with rural opportunities so that you know the proximity to larger cities as well as what makes up the rural community’s healthcare infrastructure. Even in the most rural of communities you can find great small downtowns for walking, excellent outdoor activities, and exceptional hospitals and practices.
Rural Often Means Support
For good or ill, the days of the solo or physician/group owned practice have largely gone the way of the home visit (though with some home-based primary models, home visits are getting a 21st century makeover). Large system employment in a rural practice often comes with additional support not available to independent practices. What this means for you will vary based on your practice, system, and location. When you interview for a rural practice position with a system, be sure to ask what the relationship is to the parent hospital. Find out how often the rural practice team engages with non-clinical staff from the hospital. Are health professionals engaged in decision making? These seemingly small factors can make a big difference in your day-to-day work and practice. I interviewed a lead physician whose rural practice was owned by a larger system. His practice experienced a fire and everyone from his rural team was pretty shaken up. Before he had time to begin to process this terrible event, his hospital C-suite came through with a plan and location to help patients get triaged during building repairs. The C-suite even came out to help. You couldn’t ask for a stronger show of hospital support than that.
Rural = Autonomy
The flipside of having hospital staff support when you need it is having autonomy within your practice. Rural practice is more likely to afford you this opportunity than one in a city and practicing at the top of your scope is not only important, it’s a hard yes in a rural practice setting. You are more likely to work with patients with severe and complex medical conditions within rural settings; having clinical and other decision-making autonomy is vital. You are more likely to develop protective factors against burn-out and enjoy a long-term rural career when you feel a sense of empowerment.
Valuing the Rural Team
Another aspect important to rural success is thriving in a team-based environment. This involves recognizing the key roles each staff member plays in your practice and how those roles impact patient care and experience. In rural practice, you quickly realize that your front desk staff will make or break your practice. While you manage the clinical side of things, make sure you have excellent staff who focus on impeccable customer service. With complex medical conditions, travel barriers, and other socio-economic challenges, rural patient care access is more complicated than whether or not there are available providers and appointments. Make sure your rural team members are empathetic, competent, and able to move mountains to achieve optimal patient care experiences.
Dual Roles in Rural
It’s true that if you work (and live) in rural communities, you will be more likely to have to navigate those medical questions that come at you on off-hours. In my city of more than two hundred thousand people, I’ve run into my daughter’s pediatrician and my primary care doctor outside of their practices (at Oktoberfest and a local park, just to set the record straight). Some rural providers set clear boundaries with patients up front, saying “I am always here for you during practice hours (or if providing hospital call), and I’d love to say hello on the street. Please contact the office if you have a medical issue and we’ll get you in.” Others opt for a little more separation by choosing to live outside of the rural community in which they practice; it’s your choice.
Access to Specialty Care in Rural
When it comes to thinking about a career in rural, health professionals are most concerned about access and proximity to networks for specialty care. Thankfully, with telehealth, the rural paradigm of limited access to specialty care is changing. Though it varies widely across the country, telehealth consultation is becoming mainstream for rural psychiatry, oncology, audiology, and countless other specialties. Be sure to check in during your interview to determine your practice’s pathways to specialty referrals and ask about telehealth. When possible, build relationships with your network’s telehealth providers and ensure that patients are aware of the benefits of telehealth. Be prepared to do some myth-busting around telehealth, especially with technology-averse Boomer patients.
Relationships are Your Jam
The thing about rural practice that sets it apart from other practice environments is the relationships you will build with patients. For some health care professionals, this is the most gratifying aspect of health care delivery, for others it’s not so important. If you are motivated to develop genuine relationship with patients, if that’s an aspect of health care delivery that feeds your soul, then rural healthcare may be the fit for you. With relationships comes responsibility, and ultimately, connection to others. And at the end of the day, your rural patients and clients will leave an indelible imprint on your life. Just as you will on theirs.
