Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, personal anecdotes are allowed as responses to this comment. Any anecdotal comments elsewhere in the discussion will be removed and our normal comment rules apply to all other comments.
Do you have an academic degree? We can verify your credentials in order to assign user flair indicating your area of expertise. Click here to apply.
Not a family physician, but I used to practice in a rural town some years ago. I was burnt out working and living in the big city and thought maybe a smaller town would offer a slower pace of life. In addition, I was used to having to work with patients who were very well off and thus also very demanding and unappreciative. I thought moving somewhere smaller would sort of help with that. Finally, since I would also be working for a small hospital, I actually got to talk with the hospital administrators and they seemed receptive enough to my goals and my requests.
Unfortunately, things didn’t turn out the way I was hoping for and I left after about a year for a number of reasons. I was only a couple years out of training at the time, so I admit I was still pretty green when it came to negotiating my contract. There were a couple of things I was pushing for that I was convinced to leave unwritten in order to get the deal done faster, while they “promised” I would be taken care of. That should’ve been the first red flag, but in my inexperience, I ignored it as I was on a deadline as well. Because of that, a lot of things that were promised to me verbally were left unfulfilled. As for the patients, they were definitely much easier to work with as a whole, but at the same time, I definitely still saw my fair share of patients who believed in pseudoscience and there were a couple that demanded certain “deworming” medications despite absolutely no legitimate indication for them. Overall, patients were fine, but the EMR system was horrible and it took twice as long to get things documented/ordered and there was still a lot of paper charting done. Finally, my personal life definitely got slower in a rural setting. Too slow. This contrasted with my work life where I found myself on call more than I thought I was going to be. Not to mention, boundaries in a small town were pretty nonexistent as I’d get calls all the time even when I wasn’t on call.
It finally hit me one day that I wasn’t getting enough, personally or professionally, out of working in a rural community so I ended up taking a significant pay cut to move back to the city.
Yep. Unless you’re from the community or a similar sized one, there really is little else to attract people that could otherwise move anywhere else and live well. There’s even less incentive if you’re a minority of any sort (e.g., ethnicity, gender, religion, hell even sports team) in an otherwise pretty homogenous or insular area.
The reason why the pay is so high is that those kinds of places are an increasingly bad cultural fit for most of the folks with the qualifications for the job
I hope I didn’t sound ungrateful for my privilege. I only made mention of some patients asking for non evidence based treatments to show the contrast in difficulties between some city vs rural patients. It took a lot of educating to convince some patients why they didn’t need certain things they saw on TV. Some understood while others decided to proceed with getting it from the local feed store and that can be frustrating.
sure but if you’re not white or black skinned or openly lgbt or a woman or whatever… often times you don’t even get to know your clients the same. the prejudice is insane in those communities.
not everyone of course but the delta is dramatically different.
Good luck convincing people of that in this sub. Many people here think it's funny when you almost die of treatable anemia because the Texas doctors didn't know or care.
Sure, but that's the trade. But, what would you do with the excess? At least when you're closer to a city theres more to do.
Yes, I get people can like being homebodies or enjoying the nature part of things, but given the decline of rural physician numbers it obviously isn't enough to stem the flow.
Nothing like your neighbors knowing you as their doctor and willing to sprawl their body parts out at you to ask for an identification of a lump outside of your hours.
I’m from the south. Roughly half of the doctors I’ve been treated by in my entire 31 years of life have been South Asian immigrants (presumably Indian but I didn’t ask). These days, most of my providers in general are NPs.
I’m terrified about what healthcare will look like here with fewer immigrants AND fewer nurses and NPs from the student loan changes.
Also when you make it hard for folks who want to come or want to stay here after medical school, they are simply returning home rather than attempting to do the conrad 30 waiver...
Not just OBGYNs, but also other providers who are women of reproductive age, are in relationships with women of reproductive age, or who have daughters who are or will be of reproductive age. Pregnancy and birth are one of the most basic biological functions of human life, and passing any laws or regulations that make either of those things more difficult will have downstream impacts on many, many other specializations. Even older providers still working in red areas will pass away or retire... who, if anyone, will be willing to replace them?
Yes, but this trend is much wider than that and much older. Medicine, overall, is being bled out of the rural areas. Doctors of all sorts, whole hospitals, and pharmacies. They’re all disappearing.
I’d say another equally awful piece is the loss of professionals (even with their flaws) means influences and true snake oil salesman can easily fill the void.
Those impacted won’t know the difference even when it hurts them or their families.
Doctors don't want to deal with aggressive morons who "did their own research".
I have a friend who tried to practice in a rural area and moved back to a city because he didn't want to deal with the abuse and threats from people coming to him for help who "did their own research".
To be fair to “people who did their own research” the only reason I got diagnosed with liver failure from a virus in time to not have permanent damage was because I told multiple doctors “it’s not f****** depression” until I got one to run a blood test that detected, you guessed it, not depression.
Totally, there's people who do their research for their health, and people who scream at doctors for recommending a child get a vaccine. Those are the "did their own research" crowd.
With respect, doctors usually don’t distinguish between the two until AFTER the patient turns out to be right. Until then, they’re viewed as a problem patient. I cannot stand the type of people you’re talking about, but I’m not going to let doctors off the hook either since they’re way more self assured than they should be.
We need more city doctors to come back to their small home towns over Christmas and fall in love with their old high school flings. This is how it works.
Family med doesn’t pay well and isn’t held in esteem like specialist roles are. Rural hospitals don’t pay well and are in boring areas. Doctors want nice lifestyles after sacrificing their 20s to med school/residency. Plus they usually have six digit loans and only have a few years of reproductive window left. They tend to seek lucrative specialist jobs in urban centers just like as everyone else
So medicine is weird in that you do actually tend to get paid more in rural areas than urban. But a lot of doctors want to live in urban centers, and the the pay cut + high cost of living is a tough pill to swallow if you were already at the lower end of compensation.
This. My husband is a general surgeon, and the base salary difference between the chiefs who stayed in the rural community they trained in versus those who left for bigger cities was literally $150k in favor of those who stayed rural.
Do specialist positions get paid more? MD salaries where am now (HCOL hub city) are far higher than they were in the city I lived in previously (relatively LCOL uni town)
Specialists do tend to get paid more. There are exceptions -- generally anything pediatric tends to pay poorly, and non-procedural specialties also tend to pay poorly.
Uni towns might be the general exception to the rule. They tend to have a lot of docs around by virtue of being university hubs, so that suppresses wages too.
In my own case - I'm internal medicine in a MCOL area about 1-2 hours from multiple VHCOL areas. I'd take about a 50-100k pay cut to work in those VHCOL areas.
That makes sense. I suspect the limited sample comprising my professional circle (mostly a specific type of specialist from a specific area) may have biased my judgment
Specialists in rural areas do make a killing, but its kind of because they kill themselves with work. When youre the only X in town, and the only one for 300 miles, it throws a lot of business your way. You can put restrictions like only people with insurance or whatnot, but you still get flooded.
Its possibly nice right out of training when your still semi-young, but its not sustainable for most people. The town I took a job in after training had one urologist. Surgical specialty, super common problems, lots of NPs in the area so endless referrals and consults. The dude must have made a killing; that said, he was pretty much working 24/7/365, maybe some exceptions for when he literally told all the bigger facilities he was going on vacation.
And its not just being blasted from medical facilities. Small towns are, well, small. This guy couldnt walk around a supermarket without being approached. From speaking to him, he also said people felt compelled to treat hima s though they had a personal relationship with him, when in reality he had no idea who they were unless he opened their chart.
Lots of other specialists I spoke to in the area said much the same, to slightly varying degrees.
That is wild, my dad is a specialist in a rural area and because there are no other specialists of his type, he's able to negotiate his contract aggressively and work 4 days a week while only being on call rarely and still make more than he would working in the urban centers in our area of the country.
I think also think building personal relationships with people in the community is part of the job he really loves and finds to be quite rewarding rather than an unprofessional/obtrusive/off-putting experience, so it probably depends on your personality type there.
I would not work in these areas even if they paid me 3 million dollars. I have given up enough of my youth and time living in geographically suboptimal places.
This isn’t the whole story, but it’s definitely a big piece. It’s part of a larger story of the medical system slowly buckling under overburdening administration & middle men and the rural areas depopulating towards the big cities.
So true! Who can blame them? I’m an RT not a doctor, but rural hospitals also lack the best equipment, the latest technology and are kind of run down too. I remember at one rural hospital I worked at and patients would ask me why the hospital looks run down and I would just say the hospital doesn’t have any money. I did a contract last year at another rural hospital and they used regulators on their oxygen tanks and I was like wth, who still uses oxygen tanks like this. And the equipment like the ventilators were so outdated that it wasn’t even funny.
Yeah, turns out when your government wants to de-incentivize rural practice while private equity gobbles up more of the healthcare sector and insurance companies simultaneously want to make it near impossible to practice ...doctors decide to move where more incentive is!
Rural communities are in for a world of hurt. Medical doctors aren't the only professionals being sought. My local bar is begging attorneys to move out to smaller communities. A couple friends I went to law school with are saying the same in the states they've moved to.
Absolutely shocking that rural areas, that consistently vote red, are anti-science, anti-education, and anti-vaccination are not desirable locations for physicians, presumably with hundreds of thousands of dollars in student loan debt and young families, don’t want to live or practice there.
Going to get a shitload worse before it gets any better. With hospitals and rural health co’s now needing to fork over $100,000 for an H-1B visa in order to bring in a single foreign relief physician, the flow of out-of-country reinforcements is quickly going to wither and die.
And it’s not just physicians; it was just reported today that one Florida health provider had more than 200 RN’s lined up and just waiting for visas. But now it would cost them $20,000,000 to bring them in. So instead they’re just going to close several of their facilities. This will of course make waiting times at their remaining facilities longer, and burn out remaining staff much more rapidly.
On the flip side, the government of Canada just announced that they were fast-tracking the work visas for 5,000 foreign doctors: this would scale to the US fast-tracking 50,000 physicians.
You broke it, all you Trump-cult country folk - you bought it! Enjoy your diabetes, edema, gout and skyrocketing blood pressure!
Lot's of rural doctors retiring, not enough to fill the empty positions.
And in some countries the incentive to be a rural GP/family practitioner has gone down the drain too.
In Central Europe it is pretty much the apocalypse of primary care in rural areas.
Though the main reasons are a lot of bad political decisions and lack of long term planning.
It’s getting worse and it’s not just physicians. I was one of the handful of dentists who took Medicaid in our county when I started about 12 years ago. Since Covid? My practice is the only one accepting new Medicaid patients within our county AND one county over.
Study after study points at the mouth being the root cause of many autoimmune issues, yet Medicaid won’t pay us enough to cover overhead costs of a simple exam and cleaning. It’s pretty shameful.
I also wouldn't want to work in/for a community that overwhelmingly voted for trump and aggressively argue/fight against ANY preventative health measures like vaccinations and even wearing a mask and yet RUN to the urgent care/ER the second they feel bad and then refuse to listen to the doctor because they "did their own research" and demand antibiotics for their cold/flu/covid.
The current administration has made cuts to many programs that financially prop up America's failing rural healthcare system. Recent changes in immigration policy are already having a drastic reduction in many medical positions that disproportionally effect rural areas. And the near future brings health care premium increases that could double and even triple.
Even prior to the pandemic, there were disturbing numbers of rural hospital closures. There are increasingly more locations where even if one has health insurance, they have to drive hours & hours to find a place where they can use it. Our current healthcare system offers no easy solutions to this growing crisis.
I am not from the US, I am from a country with socialized healthcare. My friend got an assignment as a rural doctor, serving several little villages.
She had to drive a lot when normally a doctor in my country has a 30 min public transport commute. That was the only downside. She got paid through the nose because they get bonuses for serving areas where no one wants to go, everybody in the region knew her and her husband and treated them like royalty, and literally every day they would get home and find some anonymous homemade cheese, sausages, fresh picked veggies or tied up chicken at the door.
Her husband was disabled after a very bad car crash. He was not a wheelchair user but he had serious mobility handicaps. And this is the only reason she left the job after a couple of years: they got fed so much amazing food by the villagers that her husband was at serious risk of needing a wheelchair because of how fat he got. I know it sounds like an exaggeration but it became a serious problem for them (she also gained something like 60kgs in 2 years).
Doctors burn out, but they also make enough money that when they hit their limit, they can just walk away from the job. Obviously not all do. But if you look around most hospitals, the average age of the attendings is something like 30-40. Very few of my colleagues are older than 50s, hardly any in 60s. Medicine really is like food service, you deal with the population at large, no filter; people are rude, demanding, and endless, and it wears you out.
The fad of today is to also go into private care/concierge. So its not that the doctors arent there, its that YOU dont see them -- unless you have decent money and can afford to see a private doctor.
It predates our current politics by a lot. This isn’t the kind of thing that moves on a dime.
Family medicine is under strain everywhere, but many rural areas are depopulating in favor of the big cities. Specialists are naturally becoming harder to find and are requiring increasing travel times as rural areas empty out. Hospitals are closing even in big cities, it’s naturally much worse outside of them. Pharmacies are folding left and right. More and more people now need to make hour drives or more to fill their prescriptions. It’s a systemwide buckling that has been in the works for decades.
It predates our current politics by a lot. This isn’t the kind of thing that moves on a dime.
That's typically true, and this has been a problem for a while, but in this particular case it's also very likely true that it IS significantly contributed to by current political climate and policy. I can say firsthand that there are a lot of people leaving rural areas because the anticipated changes proposed and approved by this administration mean many of these hospitals will be closing.
These things don't usually move on a dime, but we aren't living in dime times. These are silver dollar sized problem times.
I wish they had the data outlining why the doctors left their practices. Was it due to pay or inclement weather? Doctors getting older and wanting to leave cold climates?
Either create programs and pay proper salaries for young doctors and nurses wanting to make a difference in these rural communities or issue visas for fully qualified doctors and nurses that are wanting to emigrate to the USA who are willing and grateful to practice here (Ukraine/Russia?). Family practices don’t pay as much as specialists, so what is the magic number to make it worthwhile to stay and grow a practice for them?
Family doctors are generally a last option for doctors when they are specializing is what I’ve learned from my brother and buddies being ER docs. Everyone wants to specialize because you get paid substantially more. IMO if the pay were equal to other specialities you would definitely generate a lot more interest in folks wanting to work in rural environments.
Its not really that different, and sometimes more or less the same.
The issue is more about dropping roots. You give up your youth for medicine. Its tough to give up the remainder of it as well. The average doctor makes several hundred thousand a year, even regular clinic docs. You get paid more in rural area, A LOT more. Despite this, its still a hard pill to swallow to move to a place with literally nothing to do and possibly/probably backwards in the whole human progress thing.
At some point people want to live life, and (from personal antecdotal experience) living in a rural town is not really living well.
Yeah, like there’s all sorts of things in a city for a well-educated, well-compensated person that you mostly wont find in a moderately to very rural area - a larger (more educated) dating pool, more cultural amenities, closer access to things like major airports for travel, if you have a partner jobs for them, etc. Even something as simple as a grocery store - literally having easy access to a wide array of produce can be hard in certain rural communities.
So let’s kneecap mid-level providers, NPs and PAs, by drastically cutting borrowing limits from $50k/year to $20.5k/year, impacting future healthcare professionals by making education more expensive.
I live in a rural California town. Since COVID we have lost a significant number of doctors. Many crashed out due to stress. Many retired, and there is no young blood taking over the practice. insurance and malpractice attorneys are keeping a lot of would-be doctors from becoming doctors.
You should see what will happen when they mess with the student loan repayment program even more. You’ll have even less doctors in the states that voted for this.
This is a known frustration as the pay in rural areas never lines up with the frustrations and challenges of dealing with rural dysfunctional systems and lack of access to basic resources.
Idea: communities band together to send promising, community service driven students to medical school. Pay all the tuition, room and board, and supply a small stipend. In return the student signs an agreement to return to their hometown and work there for 6-10 years or so. If they fail to do that, they have to pay back the money that was invested in them.
No offense but while this is an option, and is done in some parts of North America, would you want to sign a contract mandating 6-10 yrs of your life have to be spent doing X in Y location? Even if you loved the area, becoming a dr already means giving up most of your 20s (for many, their best years), and then to give up your 30s to go back to a small town? Doesn't sound very appealing to me, but to each their own.
A big part of the problem is there aren’t necessarily enough people in a lot of these communities anymore for this. Not to mention, a small community sending one or two people to medical school to save them all is a heavy burden to place on people, especially since it would probably start in their early teens.
PSLF is also on the chopping block and pretty risky to base your career off of at this point. Strengthening PSLF and protecting it from the whims of whatever fuckface is in office, along with adding incentives for these rural areas would help, if that's even possible. No one wants to take a less-than desirable position on a super shakey promise of loan forgiveness.
States can also have scholarships that accomplish this. The condition simply being that they practice in any rural county under some threshold of doctors to patients within a given specialization.
If they had the willpower, I think they could. I grew up in a rural county that is struggling. The county population is around 50k people. Let's go down from there and say a rural county has a population of 10k. Half a million is $50 per person. If they issue one such scholarship every 5 years, that's $10 per person per year. (And yeah, some are kids or dirt poor can't spare $1 per month, etc. but there are also people who could afford $2 per month.) Would it take political willpower, argument, cajoling, and be difficult to implement? Of course. But far from impossible.
I hope those rural folks figure out a solution that works for them, but without government aid that the politicians they elect oppose, the economics are pretty daunting, since they are poorer and have less population density but have to pay more to attract talent.
An 11% drop sounds abstract, but rural family docs are basically the “front door” of the whole healthcare system. Lose them and you don’t just get longer drives, you get later cancer diagnoses, more unmanaged diabetes, more strokes. We already see rural‑urban mortality gaps widening; this just bakes it in unless payment, workload, and support structures in those areas change, not just “recruitment campaigns.”
Amazon has an rx service now I think. So is it possible that corps like walmart and amazon become the only way for rural folks to get healthcare? I'm genuinely curious because I know walmart destroyed small business in the south which is why they buy almost everything at walmart since there's nothing else carrying the products they need for miles. So does anyone think that could happen with amazon's new prescription drug service?
It's kind of what happens when you have such a messed up culture and a government that isn't actually willing to improve the lives of citizens when it doesn't earn them any kickbacks.
Welcome to r/science! This is a heavily moderated subreddit in order to keep the discussion on science. However, we recognize that many people want to discuss how they feel the research relates to their own personal lives, so to give people a space to do that, personal anecdotes are allowed as responses to this comment. Any anecdotal comments elsewhere in the discussion will be removed and our normal comment rules apply to all other comments.
Do you have an academic degree? We can verify your credentials in order to assign user flair indicating your area of expertise. Click here to apply.
User: u/iamphilosofie
Permalink: https://www.annfammed.org/content/23/6/535
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
Not really surprising. Turns out when you make it difficult for doctors to practice, doctors move to the places where it's easier to practice
Not a family physician, but I used to practice in a rural town some years ago. I was burnt out working and living in the big city and thought maybe a smaller town would offer a slower pace of life. In addition, I was used to having to work with patients who were very well off and thus also very demanding and unappreciative. I thought moving somewhere smaller would sort of help with that. Finally, since I would also be working for a small hospital, I actually got to talk with the hospital administrators and they seemed receptive enough to my goals and my requests.
Unfortunately, things didn’t turn out the way I was hoping for and I left after about a year for a number of reasons. I was only a couple years out of training at the time, so I admit I was still pretty green when it came to negotiating my contract. There were a couple of things I was pushing for that I was convinced to leave unwritten in order to get the deal done faster, while they “promised” I would be taken care of. That should’ve been the first red flag, but in my inexperience, I ignored it as I was on a deadline as well. Because of that, a lot of things that were promised to me verbally were left unfulfilled. As for the patients, they were definitely much easier to work with as a whole, but at the same time, I definitely still saw my fair share of patients who believed in pseudoscience and there were a couple that demanded certain “deworming” medications despite absolutely no legitimate indication for them. Overall, patients were fine, but the EMR system was horrible and it took twice as long to get things documented/ordered and there was still a lot of paper charting done. Finally, my personal life definitely got slower in a rural setting. Too slow. This contrasted with my work life where I found myself on call more than I thought I was going to be. Not to mention, boundaries in a small town were pretty nonexistent as I’d get calls all the time even when I wasn’t on call.
It finally hit me one day that I wasn’t getting enough, personally or professionally, out of working in a rural community so I ended up taking a significant pay cut to move back to the city.
There's a reason they want/have to pay $450k for family practice docs in Sioux City/Falls, or the middle of nowhere, NE.
Yep. Unless you’re from the community or a similar sized one, there really is little else to attract people that could otherwise move anywhere else and live well. There’s even less incentive if you’re a minority of any sort (e.g., ethnicity, gender, religion, hell even sports team) in an otherwise pretty homogenous or insular area.
[deleted]
The reason why the pay is so high is that those kinds of places are an increasingly bad cultural fit for most of the folks with the qualifications for the job
That’s a very diplomatic way to phrase it. Wait til it’s even harder to get med school loans due to the new caps and the total pool is even smaller.
The patients were the only saving grace of the place. I developed some very rewarding relationships even though I was only there for a short time.
Thank you for everything you do.
I hope I didn’t sound ungrateful for my privilege. I only made mention of some patients asking for non evidence based treatments to show the contrast in difficulties between some city vs rural patients. It took a lot of educating to convince some patients why they didn’t need certain things they saw on TV. Some understood while others decided to proceed with getting it from the local feed store and that can be frustrating.
You are awesome, and appreciated. I’m just too exhausted to expand on my thoughts further. Just know, thank you.
sure but if you’re not white or black skinned or openly lgbt or a woman or whatever… often times you don’t even get to know your clients the same. the prejudice is insane in those communities.
not everyone of course but the delta is dramatically different.
Good luck convincing people of that in this sub. Many people here think it's funny when you almost die of treatable anemia because the Texas doctors didn't know or care.
People in this sub think that is funny...?
Sure, but that's the trade. But, what would you do with the excess? At least when you're closer to a city theres more to do.
Yes, I get people can like being homebodies or enjoying the nature part of things, but given the decline of rural physician numbers it obviously isn't enough to stem the flow.
There's also Concierge Care.
Concierge Care as in driving to patients?
https://en.wikipedia.org/wiki/Concierge_medicine
Direct care via monthly or annual retainer.
I think this is where rural is going. God forgive those that are poor.
Gonna have one doctor for 2500 square miles, and no hospitals.
Meanwhile they'll parrot some nonsense about Canadian waiting lists.
Nothing like your neighbors knowing you as their doctor and willing to sprawl their body parts out at you to ask for an identification of a lump outside of your hours.
Plus turning against immigration/foreigners. Often times doctors from outside the US get stuck in residencies in smaller or rural towns.
I’m from the south. Roughly half of the doctors I’ve been treated by in my entire 31 years of life have been South Asian immigrants (presumably Indian but I didn’t ask). These days, most of my providers in general are NPs.
I’m terrified about what healthcare will look like here with fewer immigrants AND fewer nurses and NPs from the student loan changes.
I work in a children's hospital. Half of our doctors and nurses are immigrants, a lot of them brown skinned.
EHR upgrades is the driver I believe
Also when you make it hard for folks who want to come or want to stay here after medical school, they are simply returning home rather than attempting to do the conrad 30 waiver...
It's projected to get a lot worse too.
The worst part about this is the people who are impacted by this and need to see the results of their choices won't take time to read it.
Even more damning is this only covered 2017-2023. My hypothesis is those numbers will look far worse over the last few years
Post Roe v Wade being struck down too. OBGYNs are fleeing red states, for good reason.
Not just OBGYNs, but also other providers who are women of reproductive age, are in relationships with women of reproductive age, or who have daughters who are or will be of reproductive age. Pregnancy and birth are one of the most basic biological functions of human life, and passing any laws or regulations that make either of those things more difficult will have downstream impacts on many, many other specializations. Even older providers still working in red areas will pass away or retire... who, if anyone, will be willing to replace them?
Yes, but this trend is much wider than that and much older. Medicine, overall, is being bled out of the rural areas. Doctors of all sorts, whole hospitals, and pharmacies. They’re all disappearing.
I’d say another equally awful piece is the loss of professionals (even with their flaws) means influences and true snake oil salesman can easily fill the void.
Those impacted won’t know the difference even when it hurts them or their families.
Doctors don't want to deal with aggressive morons who "did their own research".
I have a friend who tried to practice in a rural area and moved back to a city because he didn't want to deal with the abuse and threats from people coming to him for help who "did their own research".
They’re rarer in urban areas but the higher population density balances things out
Large hospitals have better security than smaller rural ones, not always the rule, lots of urban hospitals are terrible as well.
And more terrible things to witness to.
Doctor here, this is way more common in urban areas. People that are rural and salt of the earth listen to whatever you say.
Especially if they get to know you, and therefore trust you more than some talking head on TV.
No they don't. They just pretend to do so to your face.
To be fair to “people who did their own research” the only reason I got diagnosed with liver failure from a virus in time to not have permanent damage was because I told multiple doctors “it’s not f****** depression” until I got one to run a blood test that detected, you guessed it, not depression.
Totally, there's people who do their research for their health, and people who scream at doctors for recommending a child get a vaccine. Those are the "did their own research" crowd.
With respect, doctors usually don’t distinguish between the two until AFTER the patient turns out to be right. Until then, they’re viewed as a problem patient. I cannot stand the type of people you’re talking about, but I’m not going to let doctors off the hook either since they’re way more self assured than they should be.
I'm genuinely curious. What is threatening about someone who asks for proper treatment and is well informed? Why do we have to play to egos?
Then maybe doctors should start taking a ferritin level of < 11 seriously instead of letting women die.
Doctors' neglect is woo's opportunity.
[removed]
You're insane.
We need more city doctors to come back to their small home towns over Christmas and fall in love with their old high school flings. This is how it works.
Hallmark needing to up their game
Family med doesn’t pay well and isn’t held in esteem like specialist roles are. Rural hospitals don’t pay well and are in boring areas. Doctors want nice lifestyles after sacrificing their 20s to med school/residency. Plus they usually have six digit loans and only have a few years of reproductive window left. They tend to seek lucrative specialist jobs in urban centers just like as everyone else
So medicine is weird in that you do actually tend to get paid more in rural areas than urban. But a lot of doctors want to live in urban centers, and the the pay cut + high cost of living is a tough pill to swallow if you were already at the lower end of compensation.
This. My husband is a general surgeon, and the base salary difference between the chiefs who stayed in the rural community they trained in versus those who left for bigger cities was literally $150k in favor of those who stayed rural.
This. You take a huge pay cut to work in the city where the job market is competitive.
Do specialist positions get paid more? MD salaries where am now (HCOL hub city) are far higher than they were in the city I lived in previously (relatively LCOL uni town)
Specialists do tend to get paid more. There are exceptions -- generally anything pediatric tends to pay poorly, and non-procedural specialties also tend to pay poorly.
Uni towns might be the general exception to the rule. They tend to have a lot of docs around by virtue of being university hubs, so that suppresses wages too.
In my own case - I'm internal medicine in a MCOL area about 1-2 hours from multiple VHCOL areas. I'd take about a 50-100k pay cut to work in those VHCOL areas.
That makes sense. I suspect the limited sample comprising my professional circle (mostly a specific type of specialist from a specific area) may have biased my judgment
Specialists in rural areas do make a killing, but its kind of because they kill themselves with work. When youre the only X in town, and the only one for 300 miles, it throws a lot of business your way. You can put restrictions like only people with insurance or whatnot, but you still get flooded.
Its possibly nice right out of training when your still semi-young, but its not sustainable for most people. The town I took a job in after training had one urologist. Surgical specialty, super common problems, lots of NPs in the area so endless referrals and consults. The dude must have made a killing; that said, he was pretty much working 24/7/365, maybe some exceptions for when he literally told all the bigger facilities he was going on vacation.
And its not just being blasted from medical facilities. Small towns are, well, small. This guy couldnt walk around a supermarket without being approached. From speaking to him, he also said people felt compelled to treat hima s though they had a personal relationship with him, when in reality he had no idea who they were unless he opened their chart.
Lots of other specialists I spoke to in the area said much the same, to slightly varying degrees.
That is wild, my dad is a specialist in a rural area and because there are no other specialists of his type, he's able to negotiate his contract aggressively and work 4 days a week while only being on call rarely and still make more than he would working in the urban centers in our area of the country.
I think also think building personal relationships with people in the community is part of the job he really loves and finds to be quite rewarding rather than an unprofessional/obtrusive/off-putting experience, so it probably depends on your personality type there.
This.
I would not work in these areas even if they paid me 3 million dollars. I have given up enough of my youth and time living in geographically suboptimal places.
This isn’t the whole story, but it’s definitely a big piece. It’s part of a larger story of the medical system slowly buckling under overburdening administration & middle men and the rural areas depopulating towards the big cities.
So true! Who can blame them? I’m an RT not a doctor, but rural hospitals also lack the best equipment, the latest technology and are kind of run down too. I remember at one rural hospital I worked at and patients would ask me why the hospital looks run down and I would just say the hospital doesn’t have any money. I did a contract last year at another rural hospital and they used regulators on their oxygen tanks and I was like wth, who still uses oxygen tanks like this. And the equipment like the ventilators were so outdated that it wasn’t even funny.
Yeah, turns out when your government wants to de-incentivize rural practice while private equity gobbles up more of the healthcare sector and insurance companies simultaneously want to make it near impossible to practice ...doctors decide to move where more incentive is!
Rural communities are in for a world of hurt. Medical doctors aren't the only professionals being sought. My local bar is begging attorneys to move out to smaller communities. A couple friends I went to law school with are saying the same in the states they've moved to.
I was confused for a moment why your local drinking establishment would need an army of attorneys.
They take drinking seriously.
There’s more overlap than you’d expect. Or maybe exactly as much as you’d expect.
Absolutely shocking that rural areas, that consistently vote red, are anti-science, anti-education, and anti-vaccination are not desirable locations for physicians, presumably with hundreds of thousands of dollars in student loan debt and young families, don’t want to live or practice there.
At least they expanded funding for medical schools and Medicare for training hospitals, right? Right?
Going to get a shitload worse before it gets any better. With hospitals and rural health co’s now needing to fork over $100,000 for an H-1B visa in order to bring in a single foreign relief physician, the flow of out-of-country reinforcements is quickly going to wither and die.
And it’s not just physicians; it was just reported today that one Florida health provider had more than 200 RN’s lined up and just waiting for visas. But now it would cost them $20,000,000 to bring them in. So instead they’re just going to close several of their facilities. This will of course make waiting times at their remaining facilities longer, and burn out remaining staff much more rapidly.
On the flip side, the government of Canada just announced that they were fast-tracking the work visas for 5,000 foreign doctors: this would scale to the US fast-tracking 50,000 physicians.
You broke it, all you Trump-cult country folk - you bought it! Enjoy your diabetes, edema, gout and skyrocketing blood pressure!
This study was in the U.S. Similarly in Canada, the govt projects Canada to be short nearly 20,000 family doctors to fill job openings by 2031. https://www.cbc.ca/news/health/international-doctors-canada-barriers-1.7428598
It is similar all over the western world.
Lot's of rural doctors retiring, not enough to fill the empty positions. And in some countries the incentive to be a rural GP/family practitioner has gone down the drain too.
In Central Europe it is pretty much the apocalypse of primary care in rural areas. Though the main reasons are a lot of bad political decisions and lack of long term planning.
It’s getting worse and it’s not just physicians. I was one of the handful of dentists who took Medicaid in our county when I started about 12 years ago. Since Covid? My practice is the only one accepting new Medicaid patients within our county AND one county over.
Study after study points at the mouth being the root cause of many autoimmune issues, yet Medicaid won’t pay us enough to cover overhead costs of a simple exam and cleaning. It’s pretty shameful.
I also wouldn't want to work in/for a community that overwhelmingly voted for trump and aggressively argue/fight against ANY preventative health measures like vaccinations and even wearing a mask and yet RUN to the urgent care/ER the second they feel bad and then refuse to listen to the doctor because they "did their own research" and demand antibiotics for their cold/flu/covid.
Nuance? Here, on Reddit? Do my eyes deceive?!
The current administration has made cuts to many programs that financially prop up America's failing rural healthcare system. Recent changes in immigration policy are already having a drastic reduction in many medical positions that disproportionally effect rural areas. And the near future brings health care premium increases that could double and even triple.
Even prior to the pandemic, there were disturbing numbers of rural hospital closures. There are increasingly more locations where even if one has health insurance, they have to drive hours & hours to find a place where they can use it. Our current healthcare system offers no easy solutions to this growing crisis.
I am not from the US, I am from a country with socialized healthcare. My friend got an assignment as a rural doctor, serving several little villages.
She had to drive a lot when normally a doctor in my country has a 30 min public transport commute. That was the only downside. She got paid through the nose because they get bonuses for serving areas where no one wants to go, everybody in the region knew her and her husband and treated them like royalty, and literally every day they would get home and find some anonymous homemade cheese, sausages, fresh picked veggies or tied up chicken at the door.
Her husband was disabled after a very bad car crash. He was not a wheelchair user but he had serious mobility handicaps. And this is the only reason she left the job after a couple of years: they got fed so much amazing food by the villagers that her husband was at serious risk of needing a wheelchair because of how fat he got. I know it sounds like an exaggeration but it became a serious problem for them (she also gained something like 60kgs in 2 years).
Big picture seems like there is a decline in all doctors. They didn't just all move to the city. They're just gone.
Doctors burn out, but they also make enough money that when they hit their limit, they can just walk away from the job. Obviously not all do. But if you look around most hospitals, the average age of the attendings is something like 30-40. Very few of my colleagues are older than 50s, hardly any in 60s. Medicine really is like food service, you deal with the population at large, no filter; people are rude, demanding, and endless, and it wears you out.
The fad of today is to also go into private care/concierge. So its not that the doctors arent there, its that YOU dont see them -- unless you have decent money and can afford to see a private doctor.
A burn out leaves you scarred though.
One is never going to be as resilient as before. So burning doctors out is going to cause massive damage in the long run.
Not to forget, not all of them walk away, as the profession has one of the highest suicide rates of all jobs.
Ah well.. the don't want science... they don't want actual medicine..so why do they need doctors?
Looks like it’s back to plants and roots and other bush medicine for my relatives in the rural areas.
It’s an unfortunate reality made worse by our current policies
It predates our current politics by a lot. This isn’t the kind of thing that moves on a dime.
Family medicine is under strain everywhere, but many rural areas are depopulating in favor of the big cities. Specialists are naturally becoming harder to find and are requiring increasing travel times as rural areas empty out. Hospitals are closing even in big cities, it’s naturally much worse outside of them. Pharmacies are folding left and right. More and more people now need to make hour drives or more to fill their prescriptions. It’s a systemwide buckling that has been in the works for decades.
That's typically true, and this has been a problem for a while, but in this particular case it's also very likely true that it IS significantly contributed to by current political climate and policy. I can say firsthand that there are a lot of people leaving rural areas because the anticipated changes proposed and approved by this administration mean many of these hospitals will be closing.
These things don't usually move on a dime, but we aren't living in dime times. These are silver dollar sized problem times.
I wish they had the data outlining why the doctors left their practices. Was it due to pay or inclement weather? Doctors getting older and wanting to leave cold climates? Either create programs and pay proper salaries for young doctors and nurses wanting to make a difference in these rural communities or issue visas for fully qualified doctors and nurses that are wanting to emigrate to the USA who are willing and grateful to practice here (Ukraine/Russia?). Family practices don’t pay as much as specialists, so what is the magic number to make it worthwhile to stay and grow a practice for them?
Family doctors are generally a last option for doctors when they are specializing is what I’ve learned from my brother and buddies being ER docs. Everyone wants to specialize because you get paid substantially more. IMO if the pay were equal to other specialities you would definitely generate a lot more interest in folks wanting to work in rural environments.
Its not really that different, and sometimes more or less the same.
The issue is more about dropping roots. You give up your youth for medicine. Its tough to give up the remainder of it as well. The average doctor makes several hundred thousand a year, even regular clinic docs. You get paid more in rural area, A LOT more. Despite this, its still a hard pill to swallow to move to a place with literally nothing to do and possibly/probably backwards in the whole human progress thing.
At some point people want to live life, and (from personal antecdotal experience) living in a rural town is not really living well.
Yeah, like there’s all sorts of things in a city for a well-educated, well-compensated person that you mostly wont find in a moderately to very rural area - a larger (more educated) dating pool, more cultural amenities, closer access to things like major airports for travel, if you have a partner jobs for them, etc. Even something as simple as a grocery store - literally having easy access to a wide array of produce can be hard in certain rural communities.
Those doctors didn't disappear. I'm sure many retired but did the rest head back towards the cities and suburbs?
So let’s kneecap mid-level providers, NPs and PAs, by drastically cutting borrowing limits from $50k/year to $20.5k/year, impacting future healthcare professionals by making education more expensive.
I live in a rural California town. Since COVID we have lost a significant number of doctors. Many crashed out due to stress. Many retired, and there is no young blood taking over the practice. insurance and malpractice attorneys are keeping a lot of would-be doctors from becoming doctors.
You should see what will happen when they mess with the student loan repayment program even more. You’ll have even less doctors in the states that voted for this.
This is a known frustration as the pay in rural areas never lines up with the frustrations and challenges of dealing with rural dysfunctional systems and lack of access to basic resources.
Ten percent loss is a decimation… so it’s accurate to say access to rural family physicians is now more than decimated.
You're technically correct, which is the best kind of correct.
Idea: communities band together to send promising, community service driven students to medical school. Pay all the tuition, room and board, and supply a small stipend. In return the student signs an agreement to return to their hometown and work there for 6-10 years or so. If they fail to do that, they have to pay back the money that was invested in them.
No offense but while this is an option, and is done in some parts of North America, would you want to sign a contract mandating 6-10 yrs of your life have to be spent doing X in Y location? Even if you loved the area, becoming a dr already means giving up most of your 20s (for many, their best years), and then to give up your 30s to go back to a small town? Doesn't sound very appealing to me, but to each their own.
They're talking about students who are from those areas and more likely to want to go back to those communities.
A big part of the problem is there aren’t necessarily enough people in a lot of these communities anymore for this. Not to mention, a small community sending one or two people to medical school to save them all is a heavy burden to place on people, especially since it would probably start in their early teens.
That’s essentially what PSLF is.
Except you can work at any non profit
They have to offer something exceeding that
PSLF is also on the chopping block and pretty risky to base your career off of at this point. Strengthening PSLF and protecting it from the whims of whatever fuckface is in office, along with adding incentives for these rural areas would help, if that's even possible. No one wants to take a less-than desirable position on a super shakey promise of loan forgiveness.
Other countries implement systems like this.
States can also have scholarships that accomplish this. The condition simply being that they practice in any rural county under some threshold of doctors to patients within a given specialization.
impossible.
except for the fact that small communities cannot afford the loans generally. you’re talking 8+ years of schooling and room and board and stipend.
that’s a half a million per student. small communities do not have that kind of capital lying around.
That’s less than most municipal bonds
If they had the willpower, I think they could. I grew up in a rural county that is struggling. The county population is around 50k people. Let's go down from there and say a rural county has a population of 10k. Half a million is $50 per person. If they issue one such scholarship every 5 years, that's $10 per person per year. (And yeah, some are kids or dirt poor can't spare $1 per month, etc. but there are also people who could afford $2 per month.) Would it take political willpower, argument, cajoling, and be difficult to implement? Of course. But far from impossible.
I hope those rural folks figure out a solution that works for them, but without government aid that the politicians they elect oppose, the economics are pretty daunting, since they are poorer and have less population density but have to pay more to attract talent.
More doctors in my city. Sweet
Nationwide= US for those wondering…
Most Redditors are American. That tends to be the case.
Yes. It’s irritating.
An 11% drop sounds abstract, but rural family docs are basically the “front door” of the whole healthcare system. Lose them and you don’t just get longer drives, you get later cancer diagnoses, more unmanaged diabetes, more strokes. We already see rural‑urban mortality gaps widening; this just bakes it in unless payment, workload, and support structures in those areas change, not just “recruitment campaigns.”
Amazon has an rx service now I think. So is it possible that corps like walmart and amazon become the only way for rural folks to get healthcare? I'm genuinely curious because I know walmart destroyed small business in the south which is why they buy almost everything at walmart since there's nothing else carrying the products they need for miles. So does anyone think that could happen with amazon's new prescription drug service?
That 11% is an average, yes? How many communities are losing 50% or more of their physicians and nurses?
It's kind of what happens when you have such a messed up culture and a government that isn't actually willing to improve the lives of citizens when it doesn't earn them any kickbacks.
What nation? Why not put that in the title?
It would be great if this sub had some rules regarding the title. It should not be ok to say stuff like ‘nationwide’ without mentioning what nation..