Resources can be scarce
Another stressor for rural and small-town physicians is access to specialists, resources, and, in some cases, vital equipment.
“We have a general surgeon but no other specialty care,” Dr. Lima said. “This means that we can do acute appendicitis, we can take out gall bladders and do hernia repairs locally, but for significant trauma care and for patients who are very sick with ICU needs, we have to transfer them.”
Weather is also a huge factor that can affect ground ambulance or helicopter travel to a larger hospital.
“If there’s a storm, instead of a 45-minute transfer via helicopter, it’s a 3½ hour drive along mountain and river roads,” said Dr. Lima.
Ultimately, Dr. McKenney wished colleagues better understood the challenges facing rural physicians.
“When I transfer a patient from my hospital to a bigger facility, it’s because I don’t have certain medications on hand or an MRI ready to go,” she said. “It’s not that I don’t know what I’m doing.”
In addition, when she calls for a consult or sends a patient to a larger facility, it’s always because of a lack of resources.
“As rural physicians, we are really well educated and well trained,” she said “Our issue is that we’re practicing in a place with fewer things. But, when we call upon you, just know that we’ve tried everything we can first.”
Dr. McKenney lives and works happily in the town she grew up in and said no place could have given her a warmer welcome. In fact, while she was still finishing school, the townspeople campaigned to get her to come back and practice there – hard to come by that in a big city.
Small-town physicians offered five tactics for making a small-town practice work successfully:
- Develop relationships with specialists in your nearest large facility for referrals.
- Consider joining an ACO to improve work flow, diversify revenue streams, and maintain independence.
- Create a culture that’s welcoming to all incoming young professionals.
- Host medical students and residents as part of their education. “If they learn about your community, your practice, and rural healthcare early on, they will be more likely to be interested in coming back to serve that same community,” said Dr. McKenney.
- Recruit more than one physician if possible. “It’s really scary for new physicians to go out and practice on their own right out of training. Most rural communities need more than one more doctor anyway, and this gives them a built-in support system from the beginning,” said Dr. McKenney.
A version of this article first appeared on Medscape.com.