Rural vs Urban Practice: The Pros & Cons

Published on: Apr 30, 2018


Hospitals and medical practices across rural America are facing a significant shortage of qualified medical professionals. Twenty percent of the country’s population live in rural areas, yet only 9% of the nation’s physicians work there. But it looks like this statistic may not improve for the foreseeable future. This could be because just three percent of medical school graduates plan to work in the countryside.

It’s clear that medical school graduates are choosing a city practice over a rural one. Why? As a physician, you’ll definitely face a different set of challenges when working in a rural practice compared to working in an urban practice. But is one really better than the other? It’s a decision you will have to make in the near future. To help you in your decision and to give you a clearer picture of your options, let’s look at life in a rural practice versus life in an urban practice to help you decide which direction could be right for you.

Treating Friends vs Treating Strangers

Serving as a physician in a rural practice gives you opportunity to get to know your patients and the local community. Unlike urban work, you can get to know patients in the context of their community. They aren’t just a name on a clipboard, they are your town grocer, the vicar or your child’s school teacher. Patients prefer this kind of relationship, too. In general, it’s nicer to have a medical professional treat you as if you are a member of your family than as a stranger. Nevertheless, some practitioners prefer to treat strangers and maintain a professional distance. It’s easier to give bad news to someone you don’t personally know.

Greater Autonomy vs Better Support

In rural practice, you will often experience greater autonomy as a doctor. Physicians are seen as community leaders and are allowed greater freedom in patient treatment. Of course, greater autonomy brings its own challenges. Medical professionals can often feel isolated and unsupported. When communities depend on a single physician, they can often be expected to be available all hours of the day. It also means they tend to work for longer periods without time off. This can lead to burnout for rural practitioners who can’t or won’t set limits to the amount of time they work. In an urban setting, physicians receive better support, but frustration can arise from the red tape of larger municipalities.

Diverse Work vs a Chance to Specialize

The scope of work is often much more diverse in rural practices. Rural physicians typically deliver more babies and make more house calls than their urban counterparts. Doctors in rural areas are also more likely to receive uncommon patient cases. Often, there isn’t a specialist in rural communities, so patients have no choice but to go to the only doctor available. There are more opportunities to specialize in an area of medicine in an urban practice. While rural practitioners often have to be a jack of all trades, the sheer number of urban practitioners means that specialization is often necessary.

Better Salary vs Better Quality of Life

Urban practices tend to offer a higher salary compared to rural ones, mostly because the cost of living is much higher in cities. Conversely, rural practitioners may be able to save on student fees in the form of federal and/or state-funded loan reimbursements. And because the cost of living is much lower in rural areas, practitioners can find that their salary goes much further. A bigger house and more spending money are not uncommon among rural physicians. As a result, rural practitioners can often end up significantly better off than their urban counterparts. Also, the pace of work will tend to match the town. In a rural setting, you’ll be able to take your time with patients and will rarely have to rush anyone out the door. On the other hand, in an urban practice, practitioners can often feel rushed off their feet and patients barely have time to get comfortable before they are out the door with their diagnosis.

So where do you stand? As you can see, there are pluses and minuses to either choice. Will you head for the bright lights of the big city? Or will you head to the country and experience the quieter, potentially more fulfilling life of a rural practitioner?




The Rural vs Urban Practice Decision JAMA Network Vol 287, Iss 1, Page 113

  Hospitals and medical practices across rural America are facing a significant shortage of qualified medical professionals.