Is Rural Solo Family Practice Medicine Still an Option for You?
“D
octor, have you ever considered opening your own practice?” is a question I’ve heard several times over the years. It came from well-meaning patients who sometimes felt the burden of trying to navigate an automated phone system, having to talk to the on-call doctor who may not know them like I did, or trying to get triaged by a nurse who may not really understand their problem. Last year, I attended a leadership conference in Kansas City held by the AAFP. One discussion with National Leadership, State Presidents, and President-Elects involved dialogue on physician workforce shortages, especially in rural and inner-city areas of the country. Most suggested that these shortages were related to reimbursement issues, and proposed increasing taxes to help fund these shortage areas. During these discussions, I was struck by the fact that I didn’t move to rural Missouri for the money. I moved there to practice full-scope family medicine, and because I was born and raised in rural Missouri and didn’t really like living in the “big city.” My wife was also from rural Missouri, and enjoyed being a part of and raising our children in a small community. I also enjoyed talking and relating to people that were like me. Farmers are really cool to talk to because they are nearly as compulsive and superstitious as we doctors are about practicing our trade. They are “real” in that they will tell you exactly what they think about the subject at hand, whether you like it or not. People in rural communities also seem to have a similar approach to life as myself. Their belief systems, desire to be independent and hard-working attitudes are just a few examples of why I feel so comfortable here. Another factor in the workforce shortage became apparent after asking a few people in the discussion room how often directors of residency programs had
solo-practice physicians or members of small towns come to their program to try to recruit residents and explain to them the benefits of practicing in a small town. Most directors told me that metro-based recruiting firms had reached out to them, or that large hospital systems most heavily recruited their residents. So, one can conclude that most residents do not have rural solo family medicine on their radar as an employment option when they finish their training. I suspect that most residents, having loans to repay along with very little training in the business of medicine, would feel intimidated even considering this possibility when most employment opportunities sound much more secure and attractive; they present the notion that “someone else” will take care of the business aspect of your practice and all you have to do is “practice medicine.” Sound familiar? What would happen if residents were exposed to the idea that rural solo family practice is a viable option? I believe it would present a feasible opportunity for family medicine doctors to move to rural Missouri to practice, especially if they knew that it could be done with little more than understanding a few business principles and working through a couple of pages of technical “to-dos”. One advantage to working as a physician/small business owner is that you really own your own business, and as such, you can eliminate committees! You get to make all the decisions, right or wrong, and live with the consequences. Fortunately for me, my office staff enjoys pointing out when I have clearly blundered on something like running out of a particular immunization that I told them I had already ordered. Setting up efficient reminder systems in the office has helped to eliminate these sorts of issues and delegation of certain responsibilities has become a learned art form. There are no hour-long meetings
Jamie Ulbrich, MD, FAAFP
MO-AFP.ORG 19
