Letters to the Editor
Scope of Practice Differences in Urban and Rural Settings
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Am Fam Physician. 2008 Apr 1;77(7):916-920.
Original Article: Responses to Medical Students' Frequently Asked Questions About Family Medicine
Issue Date: July 1, 2007
Available at: http://www.aafp.org/afp/20070701/99.html
to the editor: The article “Responses to Medical Students' Frequently Asked Questions About Family Medicine,” provides valuable and important information; however, the answer to the question “What is the scope of practice for family physicians?” is incomplete. The authors give a good general idea of the scope of family medicine but do not differentiate sufficiently according to the practice location, specifically urban versus rural settings.
My experience of going from a small community program to an urban practice was surprising. I observed significant differences between the two settings, and recent research supports my findings. Rural family physicians are more likely to be in private or solo practice, spend more time on call, perform a broader range of procedures, and provide obstetric care.1,2 Rural physicians perform more suturing, musculoskeletal injection and aspirations, casting and splinting, lumbar punctures, and nursing home and palliative care.3 Visits for acute injury and pain are more common in rural practices, whereas urban practices have more visits for general medical examinations and preventive services. Urban physicians have more access to medical resources compared with rural physicians.2 Patient populations in rural areas are more racially homogeneous than urban patient populations, and rural physicians provide more care to children than do urban physicians.4
It is crucial to describe the distinction between rural and urban practices so that medical students can make an educated, informed decision when choosing family medicine as a specialty. These differences will also help them in selecting the appropriate training program based on their future goals.
1. Baldwin LM, Hart LG, West PA, Norris TE, Gore E, Schneeweiss R. Two decades of experience in the University of Washington Family Medicine Residency Network: practice differences between graduates in rural and urban locations. J Rural Health. 1995;11(1):60–72.
2. Rabinowitz HK, Paynter NP. MSJAMA. The rural vs urban practice decision. JAMA. 2002;287(1):113.
3. Hutten-Czapski P, Pitblado R, Slade S. Short report: scope of family practice in rural and urban settings. Can Fam Physician. 2004;50:1548–1550.
4. Probst JC, Moore CG, Baxley EG, Lammie JJ. Rural-urban differences in visits to primary care physicians. Fam Med. 2002;34(8):609–615.
in reply: We agree with Dr. Marfatia's points about the many differences between rural and urban family medicine practices. Individual practices may vary based on types of procedures offered, the community needs, and patient populations. Although variations in the scope of practice of rural and urban family physicians exist, both groups share a commitment to providing patient-centered medical care that is responsive to community needs. The authors recognize that the best way for medical students to learn more about the breadth of family medicine—including rural and urban practice—is to spend time with family physicians engaged in the type of practice they are considering. Information for students on planning a preceptorship is available through your local family medicine department or by contacting the American Academy of Family Physician's Division of Medical Education (Amy McGaha, MD, 913-906-6000, ext. 6710).
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