Given that rural communities across the country are facing a shortage of primary care physicians, research that looks at how to get physicians into rural practice and keep them there is important.
That's why a recent article detailing how female family physicians in small towns and rural communities across the country seemingly "do it all" by managing patient care and their home/family life is timely.
The qualitative study, "Rural Women Family Physicians: Strategies for Successful Work-Life Balance,"(www.annfammed.org) appears in the May/June issue of Annals of Family Medicine.
In their introduction, the authors noted that residents of rural America often travel long distances to see a primary care physician, and statistics show that these communities often face a "disproportionate shortage of women and minority physicians."
- New research published in the May/June issue of Annals of Family Medicine looks at strategies female rural physicians employ to ensure success in practice.
- The study authors identified three key areas discussed by physicians they interviewed: supportive relationships, flexible work hours, and clear boundaries between work and personal life.
- Corresponding author Julie Phillips, M.D., said practices and communities that recruit female physicians should consider policies related to maternity leave, readily available child care and overall physician support.
Researchers highlighted the strengths that female physicians bring to the rural health care table -- including an ability to get female patients to complete screening tests. Female physicians are also more likely than their male peers to deliver babies, said the authors, an important practice characteristic since many rural communities rely on family physicians to provide obstetrical services.
"Promoting the success of women family physicians in rural communities is therefore important for community health," stated the authors.
Corresponding author Julie Phillips, M.D., M.P.H., is an associate professor of family medicine at Michigan State University (MSU) College of Human Medicine in Flint and a faculty member at the Sparrow MSU Family Medicine Residency in Lansing.
Phillips told AAFP News that she's not a rural physician, but her overall interest in workforce issues prompted her to investigate this topic. When the research team conducted a literature search on women in rural practice, they found an uptick in the number of women committing to rural practice, but nothing about strategies they used to make their work possible, said Phillips.
For the study, 25 women -- all family physicians practicing in rural communities and representing 13 states, from Vermont to California -- described through an interview process strategies they used to achieve a successful work-life balance.
Authors discovered that the women's successful rural medicine careers were facilitated by
- supportive relationships with spouses and partners, parents or other members of the community;
- reduced or flexible work hours; and
- maintenance of clear boundaries between their work and personal lives.
Phillips was most intrigued by the level of support the women needed "to make their work doable and how much they really worked to build that support."
Many of the women's male partners had "primary responsibility for managing the household and caring for children," said the authors. "By taking this caregiver role, they allowed their physician partners to be more available to patients."
Regarding the spouses' work arrangements, many of them were self-employed or worked part time, the authors noted, while some had professional careers but worked remotely with urban colleagues.
Furthermore, "Many participants described the support of their life partners as essential for career success." Researchers said physicians acknowledged the sacrifices their partners made and that without those sacrifices, "their chosen professions would not be possible."
Some families also relied on grandparents for assistance with child care or found flexible caregivers outside the family. One physician told interviewers that if she had a patient in labor and needed her mother to come to the house at 2 a.m., she came. "She knows my call schedule and knows what's going on," said the physician.
From Phillips' perspective, "It was very interesting how there was this whole unseen, unacknowledged network of people that allowed the physicians to be available to their patients. It showed there is another side to being successful -- that in order to be a successful physician, it helps to have a team behind you."
Supportive Practice Partners, Flexible Work Hours
According to the study, many physicians interviewed chose rural practice to maintain the broad scope of practice that family medicine allows, including obstetrics, inpatient care, home visits, emergency care and outpatient office hours.
But with that combination of patient services comes great unpredictability in the number of hours worked each week. In fact, when asked about weekly work hours, one physician responded, "Between 40 and 80."
Phillips noted that women reported much support from their practices in the form of flexible work schedules including, in some cases, part-time hours. "And having practice partners who were willing to help out when family obligations arose was important," she added.
One physician said that resisting the urge to move from part-time to full-time employment just to earn more money had been a key decision for her. "If I didn't have those days in between to recharge … or do the laundry, for heaven's sake, I don't know how I would have raised kids," she told her interviewer.
Many physicians said that limiting work hours and protecting personal time "was essential for their well-being" and allowed adequate time for vacation, recreation and parenting.
"Once a year, I take a vacation out of the country, and I don't work Sundays," said one physician.
Physicians also reported reframing "patient expectations" about physicians' days off or approaching them with medical questions in a public place. One physician described her method of redirecting: "I'll give them (patients) a bit of advice but then say, 'Call Tuesday morning and bring them in.'"
But even though physicians took steps to protect their personal time, Phillips said they also exhibited "a really strong sense of devotion to their patients and commitment to their communities."
It was clear that for the most part, physicians also loved their jobs, said Phillips. "So even though the work is difficult and demanding, they also viewed it as being incredibly important and valuable and rewarding work."
Researchers noted that although the study showed women were able to build successful careers in small communities, "the obstacles to rural practice should not be minimized."
Women with young children and those new to practice faced significant challenges, said the authors, and they suggested that practices and communities recruiting physicians consider the needs of families as part of those efforts.
"One message that comes out of the study is that for women to be successful in rural practice, they really do need a lot of support," said Phillips. For instance, when communities are trying to recruit women to rural medicine, they need to consider policies related to maternity leave, readily available child care -- even in the middle of the night -- and overall physician support.
"Those are ways that a community can make a relatively small investment and make a really big impact," she said.
Phillips added that medical educators can help increase the number of female physicians recruited to practice in America's smaller communities by exposing medical students to rural practice. "Students have to see role models -- they have to see that it's feasible or it won't be something they'll really consider," she said.
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