I live in a fairly small city with a population of
about 40,000. The nearest large city is
90 miles away, a 90 minute drive.
Between my city and that large city, it is mostly wide open spaces.
We have many doctors, but not many specialists. We have one hospital – or as they call it, a
Regional Medical Center. As I and
thousands of others in the “baby boomer” generation grow older, we will likely have
more need for Cardiologists, Gastroenterologists, Orthopedic Surgeons, and
more.
I just learned that my Pulmonologist, the only one in
the city, is leaving the state next month.
My OB/GYN left the city a couple years ago. Now we have only one remaining. We have two gastroenterologists, one of whom
is near retirement age.
Many physicians do not want to practice in cities with
a poor economy. While many rural areas
are in economic decline, because we have a large military base, our city has
not suffered quite as much as most small cities or the rest of the nation. So the economy is not really a factor here.
A survey conducted a few years ago revealed that only 4
percent of medical residents ranked communities with fewer than 25,000
residents as their top choice of where to practice. More than half chose to
practice in areas less than 10 miles from their residency programs, which are
overwhelmingly located in big cities.
While our population is higher than 25,000, it certainly cannot be
called a big city.
I recently learned that in many specialties, the
highest earners are found in towns of 50,000 to 250,000 in size, not in the
largest metropolitan areas. There is
less competition; insurance company reimbursements are actually higher in small
to mid-sized cities; and the cost of practicing is lower in these cities. Fewer malpractice law suits are generally
filed in smaller cities, making the cost of malpractice insurance lower as
well.
Sub-specialized physicians – those who need to be part
of a major medical center with advanced equipment and every specialty at their
fingertips – do not fit into this higher-income category. With those specialists, their patients travel
to them, and income and competition are not affected the same as most primary
specialties.
I have taken that 90-mile drive to the “big city” to
see various specialists over the years I have lived here. As I get older, I have become more concerned
about this lack of specialists. Since
they could actually earn more, or at least spend less to practice here, why do
we have fewer physician specialists?
From everything I have read, it may be less about money, and more about
proximity to family, fine dining, cultural availability (the arts) and various
other reasons unrelated to the economy.
So for those of us living in my city and many other
rural communities, we have a choice of moving to a bigger city or continuing to
drive great distances for medical care.
For many, neither option is possible, making it a frightening situation
for many poor and elderly residents.
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