Rural Versus Urban Primary Care Wars

As the primary care crisis grows, it seems rural areas are seeing their competitors snatch up primary care doctors who were supposed to return to their community after training:

Competition for physicians pits rural communities against each other, and many of those “may, in fact, be losing out to urban hospitals,” said Creighton's Frey. “Unless some major changes occur in the physician work force, the future is very frightening.”

Marvin Neth, administrator of Callaway District Hospital in central Nebraska, said he believed he had a doctor signed up through a federal loan-forgiveness program a few years ago.

But a bigger hospital recruited the physician away, most likely by agreeing to pay the loans and the penalty for not fulfilling the physician's obligation to the rural health care program, Neth said.

Addding to the crisis is the fact that some primary care doctors quickly find the workload and lifestyle untenable and decide to specialize:

Rural areas have battled the health care access problem for a long time. Many rural physicians have patient volumes that are too high and are on call too much to make that lifestyle appealing to young physicians.

Dr. Matthew Johnson joined a North Platte, Neb., group of several internal medicine physicians about four years ago. As a young newcomer, he was to gradually take over the patients of a physician who was easing into retirement. But the physician retired immediately.

“The clinics were full,” Johnson, now 34, recalled recently.

He was swamped and frequently worked 80 hours a week. He saw patients in his office, in the hospital and sometimes in the aisles at Walmart, where they would complain that they couldn't get in to see him and went to the emergency room instead.

Johnson recalled thinking: “I can't do this for 30, 35 years.”

Johnson said he neglected his wife and two children and grew irritable. “I'd treat my patients better than I'd treat my family.”

Last year, Johnson left that practice to study at UNMC to become a heart specialist. He knows he'll work hard as a cardiologist, but not 80-hour weeks, and he'll make more money.

“Cardiology's been all that I expected,” he said.

"The grass is always greener...", I guess.

-Wes