A recent short commentary, (Full Text Link:“And How Long Will You Be Staying, Doctor?”) (H Kovich, NEJM 2017; 376: 1307-9), provides a great deal of insight into rural medicine.
- “Twenty percent of the U.S. population is rural, but only 11% of physicians practice in rural settings, even though residents of rural areas are older and have worse health indicators.”
- “Physician supply is driven by where physicians want to live, not by the health needs of the community.”
- “The nearest tertiary care hospital is another 3 hours away. We don’t refer often.”
- “Caring for entire families helps me understand my community.”
- Physicians leaving: “there is guilt for the person who left, insecurity for the one left behind…Should I leave too? It sounds nice to live in a neighborhood with Trader Joe’s, high-speed internet, and babysitting grandparents.”
- Patients still ask me [after 7 years] “The Question at least twice a day. “You’re not leaving soon, are you?” …I tell them honestly, I have no plan. I don’t tell them that I’m undecided about buying a new dining-room table…I’m torn between buying a nice one that fits this space and getting a cheap one. If I move, I might want something different in a new house….[my friend] “Buy a nice one for this space,” she says.”
My take: Currently there are not enough primary care physicians. Rural settings suffer this deficit disproportionately and it increases inequities.
Related blog post: Zip Code vs. Genetic Code