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Is Compensation Enough to Lure Physicians to Rural Medicine?

Op-Med is a collection of original articles contributed by Doximity members.

Doximity’s 2018 U.S. Physician Employment Report sheds light on the national physician demand and associated compensation growth. Unsurprisingly, PCPs continue to be most in demand throughout the country. Tucson, AZ, saw the highest growth in physician employment opportunities, along with Chicago, St.Louis, Baltimore, and Los, Angeles. Surprisingly, the highest growth in compensation was experienced in rural areas of Fresno, CA, and Fayetteville, AR. The lack of association between areas of compensation growth and employment opportunities may allude to the difficulty in recruiting physicians to rural areas, often necessitating higher salaries to recruit and retain healthcare providers.

In the landscape of American healthcare, rural citizens are at a significant disadvantage when it comes to receiving healthcare services. In my own specialty of Obstetrics and Gynecology, the disparity in the number of providers in urban vs. rural areas is striking. For example, San Jose, CA, has one of the highest concentration of Ob/Gyn with 55 Ob/Gyns per 100,000 women, where as Riverside, CA, has 5 Ob/Gyns per 100,000 women. Even more troubling is the number of counties where there are no Ob/Gyns.

Per Dr.Neel Shah, MD, MPP, founder of Costs of Care, “50% of U.S. counties do not have any qualified obstetric providers—this includes obstetricians, midwives, and family medicine doctors who deliver babies. This means it is not uncommon for women in broad swaths of the country to drive hours to find a qualified provider, which means they may miss out on prenatal care as a result. Then they have to drive several hours to find a hospital that delivers babies—and be confronted with many decisions around procedures like C-sections that they’re not informed enough to make. We appear to be combining the problems of the third world and the first world in a perfect storm.”

It should perhaps come as no surprise that rural Americans also carry the brunt of health complications. A recent study from the National Center for Health Statistics showed that the rate of congenital malformations, SIDS, and unintentional injuries were highest for infants living in rural counties compared to urban areas. Rural Americans also die from heart disease, cancer, and respiratory diseases at a higher rate per a report from the CDC.

Being reminded of these stark disparities, it is reasonable for the majority of compensation growth for physicians to be concentrated in rural America, but I wonder if compensation alone is enough to attract physicians to practice in need-dense areas. Often physicians are afraid to take the leap into rural medicine given the lack of administrative support and sub-specialty services as well as an almost certain ballooning of patient load. These are arenas to target improvements as a means to make rural medicine appetizing to a generation of physicians who are hesitant to leave the comforts of urban life. Until then, unless there is a dramatic shift in migration of U.S. population from rural to urban, the need to provide adequate and reasonably accessible health care for these patients will loom large.

Dr. Jerome Chelliah is a resident physician in Obstetrics and Gynecology as well as a 2018–2019 Doximity Author.

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