It’s no secret that different clinical settings bring different work experiences for the clinicians who staff them. Just as an emergency physician in a rural area won’t expect a high influx of gunshot wounds, for instance, an urban hospitalist may expect to see fewer visits stemming from chronic conditions than a rural clinician would, depending on their specialty, role, and the location they work in. It’s the reason location plays such a role as a clinician leaving school or switching positions decides where to work.
In practice, that same rural vs. urban split represents perhaps one of the biggest sets of clinical differences out there, a fact worth knowing with the number of rural assignments available to locum tenens professionals in the medical, dental, and mental health fields. Rural postings are sometimes considered a world unto themselves in health circles — especially among those who’ve only worked suburban and urban populations. Let’s explore a few of the conditions professionals in each field might expect to see as they accept postings in rural facilities.
Rural Primary Care
As the above-linked Georgetown University research notes, rural residents are more likely to undertake risky behavior than their urban counterparts. On average, rural patients are more likely to be smokers, more likely to drink five or more alcoholic beverages a day, and more likely to say they “never” exercise than their urban counterparts, for three examples.
Because of this and other factors — dietary choices, for example — chronic conditions may play a larger role in the rural clinician’s life than the urban professional’s. Per the same Georgetown research, heart problems, hypertension, arthritis, and diabetes all occur at a higher rate in rural patients (male and female) than urban, further underscoring the fact. Perhaps unsurprisingly, rural patients are also more likely to report limitations in several different types of activities, including social, physical, and cognitive.
For the primary care clinician looking to acquire experience with chronic conditions, this makes rural areas an interesting opportunity for locum tenens assignments. More to the point, locum professionals wishing to serve rural areas can do so without incurring the usual financial risk. Because rural patients are more likely to pay a larger portion of their bill out-of-pocket — and because locum professionals are paid an agreed-upon rate no matter how the patient ultimately finances their visit — there is something to be said for a temporary stay in a rural facility.
Colloquially speaking, many dentists who share stories about rural facilities talk about the cases of extensive tooth decay they encounter. Dr. Lanette Sikes claims that her time working facilities in Houston (population: 2.3 million) and Cleveland, Texas (population: 8,127) were worlds apart in this respect. Where Houstonites were more likely to engage in preventative work, she says, Cleveland’s residents tended to need “complex” restorative jobs. Severe tooth decay and whole-mouth treatments were the norm, difference also reflected in a 2004 study of urban and rural dental clinics. Per the research, “dentists in completely rural areas performed more corrective procedures” than metropolitan/urban dentists did.
This high-level difference shows up in a broad array of personal testimonials and — to lesser degree — qualified research, suggesting dentists with the desire to perform restorative procedures may have greater chance to impact lives in dental areas. The same locum tenens advantages mentioned previously also appear for dental professionals: Because a higher number of patients tend to pay out-of-pocket, locum dentists have the opportunity to do highly meaningful work without worrying about pay.
Just as important, locums in the field can provide important services for a set period and leave instead of needing to set down roots in a town they may not wish to live in permanently.
Rural Mental Health
Unlike primary care and dental health providers, who may see significant variation in the types of disorders and illnesses they treat based on the locale they choose, the largest difference mental health professionals face is the clinical environment itself. Due to a number of factors, including a lack of coverage and a larger stigma surrounding those who seek mental health help, a rural facility will likely be slower and thus less-staffed. There’s also a common colloquial idea that patients a rural facility does see may embody more developed or even destructive problems, because the stigma may keep those with relatively mild issues from seeking help.
Given the problems a lingering mental health issue can cause in a patient’s life, then, the same benefits of locum tenens mentioned in previous sections have potential to be even more profound here. Mental health pros choosing assignments in rural facilities — facilities themselves being relatively rare in rural settings, given the deep staffing gap — inherently help a facility in great need. They also get the advantage of a consistent pay rate, because possible insurance and billing issues never make it back around to the visiting locum.
Have you ever worked in a rural facility? What issues, conditions, and disorders did you find to be more common? Share your thoughts in the comments below!