The Pleasures of Rural Medical Practice

The image of rural areas as places where physiciansare in short supply and those who practicemedicine are on the bad end of the incomestick may not be true, according to a study bythe Center for Studying Health System Change (HSC;www.hschange.org).

Yes, there are fewer doctors in the nation's ruralareas, but residents of these areas still receive adequatehealth care. And although incomes for all physicians arelower, rural primary care doctors do better on averagethan primary care doctors in urban areas and havegreater purchasing power.

Rural Life Realities

The numbers don't tell the whole story, accordingto HSC. Statistics show that rural areas have 53 primarycare doctors (ie, internists, family/general practitioners,and pediatricians) and 54 specialists forevery 1000 people who live there. In contrast, urbanareas have 78 primary care physicians and 134 specialistsfor every 1000 residents.

Although some take these numbers to mean that ruralresidents lack access to medical care, the HSC study suggeststhat the numbers may actually indicate a surplus ofdoctors in urban areas. According to the study, only 6% ofrural residents reported unmet health care needs in the pastyear, compared with 7% of urban dwellers who reportedunmet needs. If there is any shortfall in medical care inrural areas, it's more likely to be linked to lower incomeand lack of insurance rather than a shortage of doctors.

Another common error about rural medical practiceis that incomes are lower than in urban areas. Althoughthe study showed that physicians in rural areas did earnless, it concluded that the difference—$204,000 vs$218,000—was not statistically significant.

Incomes on Par

The study also pinpointed some specialties whereincome for rural practitioners is actually higher thanthat of their urban colleagues. For example, the averageincome for a rural primary care physician is$170,000, compared with $161,000 for those whopractice in an urban setting. In addition, family/generalpractitioners do even better in rural areas, earningan average $175,000 a year, against $156,000 for anurban family/general practitioner.

Medicare has helped boost the income of rural doctorsby enhancing its Incentive Program, which providesbonus payments for doctors who practice in designated,mostly rural, doctor-scarce areas. This change is in additionto many existing programs that encourage doctorsto work in underserved areas, many of them rural.

Dollar Power

Income for rural doctors looks even better when it'sadjusted for the cost of living, which tends to be higher inurban environments. When the numbers are tweaked toaccount for differences in buying power, the average ruraldoctor's income rises to $225,000, while the averageincome for an urban practitioner drops to $199,000.

One reason:

Among rural primary care doctors, real incomerises to $199,000 after cost-of-living adjustments,while the average income for an urban primary caredoctor drops to $145,000. In addition to a lower costof living, rural practice frequently offers a less abrasivelifestyle. Despite the advantages, rural practicemay still not be attractive to many doctors. Rural primary care doctors work longer hours,on average, than their urban counterparts, addingabout 5 hours to the typical workweek.

There are other drawbacks, too. According to theNational Rural Health Association, doctors who setup practice in rural areas are faced with distinct problemsin addition to longer hours and a possible loss ofincome. If a doctor's spouse works, for example, jobopportunities in a rural setting may be limited.Opportunities to continue medical education may alsobe scarce, along with many of the social and culturalamenities that are plentiful in urban areas.