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Thursday Apr 17, 2014

Benefits of Rural Practice Make Sacrifices Worthwhile

Editor's note: More than 85 percent of new physicians are employed, compared to 63 percent of all active AAFP members. This is the third post in an occasional series of blogs that will look at the different roles family physicians can play.

I grew up in a town of 40,000 people. In the region where southwest Missouri meets southeastern Kansas and northeast Oklahoma, that passes for a metropolis.

During my time at nursing school and later during my first year of medical school in Kansas City, it never occurred to me that I might wind up in a small, rural practice. I hadn't grown up in a rural area, and the possibility of moving to one wasn't on my radar.

Stockton, Kan., hadn't had its own physician for more than a decade when my husband and I opened our practice in the small, rural community.

But during my second year of med school, we had the option to experience a rural health weekend. We were paired with a rural physician and allowed to see what they do and how they do it. Fortunately for me, I was matched with family physician Jen Brull, M.D., in Plainville, Kan.

It didn't take long for her to make an impression. I met one family Jen had delivered two babies for. She also cared for the mom and dad, grandparents and even great-grandparents. The relationship she had built with that family grabbed by attention. I was definitely intrigued.

Coming from the University of Kansas Medical School in Kansas City, I knew how easy it was to get lost in a big practice. In Plainville (population 1,900) I saw what a big difference a family physician could make in a small town.

During our third year, we were required to complete a rotation in family medicine. I asked if I could do mine in a rural setting rather than in the local, metro area. Given that option, I went back to Jen's practice in Plainville. I got away from the large, academic medical center and watched this small-town physician connect with her patients and her community in a meaningful way.

I loved my experience in Plainville, and I was eager to go back. So when it was time for a rural rotation during my fourth year, you probably can guess where I went.

If KU hadn't provided opportunities for us to experience rural practice, my husband (who also is an FP) and I never would have wound up in rural medicine. By the time we completed medical school and residency in 2011, we knew we wanted to settle in a rural, underserved area.

At a time when most of our peers were seeking employment, my husband and I were looking to open our own practice. Sixty percent of AAFP members are employed physicians, and AAFP surveys tell us that only 13 percent of those employed FPs have an interest in becoming practice owners. Furthermore, only 11 percent of active AAFP members practice in rural areas.

But off we went to become business owners in small-town Kansas.

And it was terrifying.

There are plenty of reasons that the trend is toward employment -- fewer headaches and greater financial security being two of the obvious factors. But it also is true that as the number of small practice owners shrink, it becomes harder and harder for medical students and residents to find mentors who have done it.

Fortunately, we found someone who is running her own small, rural practice and doing it well. In fact, Jen was one of three physicians in the area who were running their own practices and sharing overhead expenses. We joined them by opening our own practice in Stockton, which is about 15 miles north of Plainville. Our little town of 1,300 hadn't had its own physician for more than a decade.

Our decision has come with some sacrifices. We don't make as much money as our residency colleagues who are hospital or large-group employees. We're not there yet.

You don't learn how to run your own business in med school or residency, either. We realized we needed a good business manager, so we hired one. However, we still have to be more involved in tracking billing, insurance and collections than our employed colleagues.

We're also responsible for things like paying for rent, supplies, utilities, staff salaries and more. When you're employed, you know the lights are going to be on when you show up for work. As practice owners, we have to worry about all these things.

Some days, I think it would be easier if it was someone else's headache. But there also is a lot to like about being your own boss. We like having flexibility and control of our schedules. I don't have to rush my patients. When I have a new patient with multiple conditions, I give them an hour so that we can address everything they need. You can't put a price on that.

We allow our staff to bring their babies to work until the children are 6 months old. After my daughter was born, I went back to work feeling comfortable because she was with me.

And I never go home frustrated because someone was unhappy with my productivity or wouldn't allow me to practice medicine the way I want to.

We like it here, and we're happy caring for our small town.

Beth Loney Oller, M.D., practices full-scope family medicine in Stockton, Kan.

Posted at 01:31PM Apr 17, 2014 by Beth Oller, M.D.

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