There is an old saying that “the bill always comes due.” That has never been more of the case for my rural solo-practice med/peds clinic than right now. It seems that every day a new bill comes in the mail or an email pings the inbox stating our annual subscription has been renewed with no signs of slowing down. Not only are they arriving but they are much heavier than they have been in the past. Payroll for my staff — Up. Medical supplies — Up. Vaccines — Up. Insurance — Up. EHR fees — Up. Billing services — Up. Taxes — Up. Everything — Up.
Much like the nation, with the inflation felt in pocketbooks and experienced in my patient’s dinner rooms, my private rural practice is pressured. My practice has existed since 2011 and this year seems to be the worst of all. Rural solo-practice is hard even in good years and it’s dying. One article explains that for rural America, Medicare pay cuts mean that “practices either have to close or have to become a part of larger corporations and we’re seeing decreased access to care for Medicare patients because some practices simply have to say they just can’t afford to take Medicare patients.” And it's not just Medicare or Medicaid (which are proportionally a larger percentage of the insured patients in rural settings), it’s commercial insurances that are also increasing administrative burden and other measures. It’s a death spiral that does not seem to have any end in sight.
There are not many small businesses I can think of where all their costs are increasing while their pay is stagnant or decreasing. It’s just not good business. But, that is what we do as physicians. We just push on and work to find new income streams to supplement our clinic and our care. I am fortunate enough to be able to perform telehealth and medical consults at a rehab hospital 45 minutes from my practice. I work long hours and miss many family dinners.
I do it for my patients and my practice. I still enjoy that interaction I have with my patients when they need help and I am able to provide it. I like seeing my newborns graduate high school and begin college. I like knowing everyone in the family and what their health problems are and how to address them. But, I don’t like the costs. Boy, do I not like the costs. These costs are not just financial, they are also physical and mental. And these costs can be a heavy load to bear!
I believe medical school and residency, especially for my generation, ingrained in us the ethic to work and sacrifice for our patients. And if I didn’t have that strong work ethic, I don’t believe my practice or my clinic would still be open. In some ways it made us stronger but I don’t think it made us better or smarter. I applaud this generation's ideas of work-life balance and feel that is the best way forward for our future generation of physicians. Yeah, yeah, I know — old school doctors are going to say “Bah, Humbug” or “what doesn’t kill you only makes you stronger.” But our training was archaic. It was abrasive and at times abusive. It never taught us about the costs of our work, financial or healthwise. We've had to learn that the hard way on the job. This job can beat you down financially, physically, and mentally. At times, I have asked myself Why go on? Why keep the doors open? Why not change directions?
Well, it may sound cliche, but I guess it’s “for my patients.” As a rural doc who has practiced in rural Tennessee since I completed residency and the majority of that time spent as an independent rural physician, I feel it is somehow woven in the fabric of my being. And as a doctor, I am not built from some superhuman stuff as many patients see us. But, for good or bad, I am built with an intense drive to not fail and to always push on. I am simply a human that does not like to lose. I think most of us physicians have that in us. It’s one of the main drivers of our profession. But man, is it getting harder and harder to see the positive among all the negative. It’s getting harder and harder to put that stethoscope on and keep walking through the door. But, just because it’s hard, it doesn’t mean you quit. My patients, my staff, and my community still need me and my services. I still have a job to do and I plan on continuing to do it until I can no longer afford the costs, either financial or physical, or my family tells me to hang it up. Their wisdom, after all, is absolute!
Dr. Christopher Burress is a med/peds physician in Bon Aqua, TN. He enjoys reading, writing, teaching, landscape painting, and spending time with his family and friends. He is a 2025-2026 Doximity Op-Med Fellow.
Illustration by April Brust
