A friend tells me that an NP recently left the area and the existing docs aren't taking new patients. Pass it on...
Good cause. I've been watching this system of recruitment for over thirty years. Recently one of my friends died after 25 years of trying to recruit for a partner "by word of mouth". He never had a partner.
My rural programs did not have the visibility needed to get the attention of medical students on campus. The current medical education environment leads eighty percent to seek a subspecialty. Among the remaining 20%, generic primary care creates limited generalists who cannot or will not provide a full array of medical services.
In Australia, the rural docs formed their own specialty because of the nonresponse of the "primary care" establishment. The Australians are trying to recruit emergency medicine graduates because of the perceived commitment to vital clinical skills in emergency medicine. They are also looking for Family medicine people, but these FP's must be able to do all of the clinical skills. Sadly, many graduating primary care physicians lack the interest and/or the ability. These issues have been briefly described in J Rural Health earlier this year.
Emergency Medicine has operationally seized the high ground by providing huge amounts of primary care and receiving over $500 per visit revenue (Ann Int Med Sept 2009) for common complaints. They have insisted on being "specialists" and have avoided enrollment in primary care reimbursement plans. Emergency Medicine has gained alliance with the medical schools and the hospital industry. Family Medicine spots are shrinking and Emergency medicine is growing. At Cornell and UCLA, emergency medicine sits right on campus and directs the hospital activity every day. On campus, family medicine does not exist.
Given current trends, when additional ER residency positions are opened, American medical students may choose emergency medicine more frequently than they choose family medicine. The rural medical school in Guatemala has started its first two residency programs. OB and emergency medicine.
Does McComb Illinois have an emergency room? I believe the BCEM and ABFMO fellowships create one option by combining skills in Family Medicine-OB-ER. Building on a three year residency, these one year programs are able to provide the skills sought by a variety of rural, frontier, and urban communities.
Hope springs eternal,
With best wishes for your professional success,
WMR
Index--Rural recruiting, medical education reform, Editor's column
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