Lastly on Friday, I attended Specialty Practice in a Rural Setting– Diamonds in the Rough given by Lisa Lahr and Audra Zastrow.
I went into the presentation thinking that I practice in a rural setting, but was I wrong in comparison to where these two come from! The town they practice in boasts a wopping 3,000 souls and the county about 24,000. I felt like I was rural by not being in a metropolitan area and being the only NCS within my entire region. If they can make specialist practice work, I can too. I’ve got about 4 times their population to work with!
The population make up you find in rural America is a little different. They are usually older, have poorer health literacy (which we recently discussed), more impoverished, more likely to be a minority, less healthy due to poor access opportunities and therefore more likely to harbor more chronic conditions/comorbidities.
As always, medical personnel are servants of the people, so what does the above mean for a medical professional in rural America? It means that rural professionals need to specialize in being a generalist! We need to able to screen for a wide array of chronic medical conditions since we may be the first or the only medical professional to take a look at these folks. We also need to have a little experience or a willingness to experience ALL settings. Many rural hospitals are the only place within reasonable driving distance to get care and they see everyone and everything from SNF to acute to outpatient to peds to community outreach. I interviewed at one of these straight out of school and this scared me! I didn’t take that one. This doesn’t mean that you can’t specialize in whatever topic suites your fancy; just that generalist skills need to be kept up to date and functional. The presenters recommended choosing your continuing ed as 1 year working a general skill and 1 year working at your chosen specialty. Being highly flexible is also a requirement. Some days you’ll have a schedule booked back to front with no time to pee. Other days you’ll be sitting twiddling your thumbs for several hours. Low-self confidence is rampant in rural medical professionals. When you doubt your skills, there’s no one else to ask questions of to make sure you’re doing what you *do* know correctly. This is why I picked IRF coming out of school.
So who would willing choose that? Usually those medical professionals grew up in rural America, have had school experience in a rural area or are on a second career. The benefits of going rural is that you get to know everyone in town,
Rural practice isn’t for everyone. Here are a few ways you can give yourself the best chance at success:
— as mentioned, aim for having a broad skill set and focus less on a deep skill set
— prioritize your caseload to what the community needs and what you want
— have an awareness of what the community needs from you and be willing to research and seek out education accordingly
— look for a solid support networking including your supervisor who is behind your endeavors, regional groups for your specialty, mentorship whether with someone local or far away, internet resources like Journal Clubs (I think every section/academy has one), social media connections. This is why I created this blog and all the social media support around it– I want some good quality PT amigos and boy have I found ya’ll ! Lots of ya’ll!
— stretch your role. Again, you may be the ONLY medial professional this patient sees, so you need to be on the look out for those chronic conditions and be a super awesome body systems screener. Also be willing to provide consults with other medical professionals. If you can act as resource, perhaps they’ll do the same for you!
— participate in the community. Since these people are generally sicker and don’t go see medical people unless they are dying (this is my dad), community outreach educational sessions are really important, like talking to the elder group at the church about fall prevention.
— families are often more involved and nosey
— remember: no public transportation
— remember: being active is 110% necessary for many for survival, think hunting and fishing for food, chopping firewood to burn in the fireplace. So adjust treatments and goals as necessary.
— remember: many of these people do not have access to computers or the internet
Getting the word out about who you are and what you can do is important in a rural setting. This involves grassroots advertising such as
— educating the other medical providers in your immediate area and also the ones in your closest larger city. Tell them who you are and what services you offer. Often, people will go the “big city” when they get ill to make sure they have the best care. Which is fine, but when the don’t need highly specialized (the deep skill set) care, they can get referred back to a provider closer to their home. But they won’t be referred to you if the “big city” providers don’t know you exist. Remember in your local folk that rural areas often have high turnover in medical professionals, so re-educate when new people come in!
— think more traditional forms of advertising instead of the internet, like radio (my grandpa would listen to the radio for HOURS while he planted or harvested out on the farm), television, newspaper, etc.
— give educational talks at civic groups like church groups, townhall meetings, Lion’s Club, Rotary, etc. Don’t get discouraged if no one shows up. Just advertise and try again!
— get into wellness– consider doing some community group exercise classes (don’t forget to consider the professional insurance obligations here)– so you community sees you as exercise expert before they get ill/injured
— send Christmas cards to referral sources (and food!) and the last year’s patients. If your face is in their face, they won’t forget you.
— use your facilities to host continuing ed open to other professionals in the area, so they can see what you’ve got
— screen patients that are already in therapy to see if they qualify for another type of treatment. For example, you’re seeing a patient for a wound, but notice they can barely teeter into your clinic without falling over. A balance screen would be good.
— do you! Participate in activities you enjoy in town (for example, I run and do yoga mostly at the moment and am a member at a local church) and let other participants know what you do, so they’ll come seek you out and tell their friends too. Volunteer work applies here too, like at a soup kitchen or the animal shelter.
— consider offering 1 time educational visits, so potential patients will know when they should seek you out. For example, tell your PCPs about how every 80+ year old is at high risk for falls and suggest every person who turns 80 get referred to you for a balance screen and education on how to prevent falls.