What is considered "rural"?

[jadawo]

A lot of people talk about "rural medicine", but what really defines rural when it comes to medicine? <100k popultion? <50k? <10k? The practical definition of rural I have in mind is the point at which a community starts to have family medicine doctors do more and more things that would be exclusive or almost exclusive to specialists in major metro areas (OBGYN, emerg, hospitalist, etc). So I guess I am really wondering at what size of community this starts to happen in Canada.

[bearded frog]

There is no standard/legal of definition of rural. For medical school applications for instance they will sometimes ask if you have lived in a "rural" community and define it by number of people or something like that. On the other hand, for return of service requirements in Ontario, "rural" is just not Toronto or Ottawa. What a FM doc does relative to others will be unique to that area, and not necessarily based on population. Thunder Bay generally punches above its weight in terms of services, for example, because it serves a large proportion of northern Ontario. Same with Prince George for BC. And small towns that are 30 mins from major metropolitan centres are not going to be considered as rural. In terms of "rural" for pay bonuses and stipends for FM then it will be defined in each province.

[Sisushi]

A little late on the reply! 

Rural is very much up to people's definition. If you're specifically thinking of family doctor loan forgiveness, they do dictate based on postal codes what counts as rural. I think the cap is at 20 000 population. It also varies province to province. I did rural family medicine in southern Ontario and still had no less than 7 allergists I could refer to in the region. I went north of Ottawa and about 2hrs north there you can do ER and the family docs did most of the psych side because we didn't have a psychiatrist. 

I've since been to rural Newfoundland and Labrador. Hoo boy. From Fri-Mon AM I was the only doctor in the hospital. Covered long term care and ER. You do ambulance escourts, air ambulance. You put NG tubes, you do minor procedures, you deliver babies. We handled gunshot wounds and car accidents. Whatever walks in that door is you. My closest tertiary centre was a 7-10hr drive away, weather depending and moose depending. Nearest back up of any sort of hospital with specialists with 2hrs away. If there's a blizzard then forget it. Our family doc on a nearby site once delivered a very complicated and high risk pregnancy because the obgyn's car went into a ditch trying to get to the hospital for it due to snow. These towns ran from 2000 - 8000 population. But a similar sized town in southern Ontario probably won't have these circumstances when there are other major centres nearby. 

Long and short of it is that it is very region dependent. Southern Ontario rural is not the same as Northern BC rural is not the same as Labrador rural. 

[MasterDoc]

43 minutes ago, Sisushi said:

I've since been to rural Newfoundland and Labrador. Hoo boy. From Fri-Mon AM I was the only doctor in the hospital. Covered long term care and ER. You do ambulance escourts, air ambulance. You put NG tubes, you do minor procedures, you deliver babies. We handled gunshot wounds and car accidents. Whatever walks in that door is you. My closest tertiary centre was a 7-10hr drive away, weather depending and moose depending. Nearest back up of any sort of hospital with specialists with 2hrs away. If there's a blizzard then forget it.

Oh wow, rural medicine sounds extremely exciting! Coming from a somewhat rural city, I was never opposed to working rural but after reading this I definitely wouldn't mind working rural in the future. 

Obviously it has added stress and workload as opposed to working in an urban setting, but do you think the pay is enough to justify all the extra things you have to do?

[Sisushi]

On 3/7/2021 at 9:12 PM, MasterDoc said:

Oh wow, rural medicine sounds extremely exciting! Coming from a somewhat rural city, I was never opposed to working rural but after reading this I definitely wouldn't mind working rural in the future. 

Obviously it has added stress and workload as opposed to working in an urban setting, but do you think the pay is enough to justify all the extra things you have to do?

Rural is very exciting! I won't lie, the pressure can be immense and the isolation is real. Especially if you go alone without a partner/family, it can be hard to make friends when everyone is a patient. Dating in small rural areas is a virtual no go. The work can be quite taxing. The pay in some areas is actually less than urban areas due to a lot of factors. I would say the thing that really makes rural worth it is how much you love that kind of medicine, and the collegiality that is much rarer is larger settings. When there's only 5 docs and 1 nurse for 2hrs around, and struggle together with the lack of resources, you really bond! 

[MasterDoc]

6 hours ago, Sisushi said:

Dating in small rural areas is a virtual no go

Oh, can you elaborate on this? I thought dating would be easier because rural folk tend to have more respect for docs than urban folk.

[frenchpress]

27 minutes ago, MasterDoc said:

Oh, can you elaborate on this? I thought dating would be easier because rural folk tend to have more respect for docs than urban folk.

I assume what they’re getting at is that when you’re in a very small town and nearly everyone can be your patient, it can be hard to date because.... you’re not supposed to date your patients. Less of an issue when your ‘rural’ town has 10,000+ people compared to say, 1000 people, but can still be a surprisingly small world.

Several rural docs I’ve worked with commute to the town they work in from another area 45-60 min+ away specifically because they want more privacy and separation from their patients / potential patients.

[Sisushi]

On 3/11/2021 at 4:04 PM, MasterDoc said:

Oh, can you elaborate on this? I thought dating would be easier because rural folk tend to have more respect for docs than urban folk.

As someone said below, it's very hard to maintain social boundaries when there are only 2000 people. They're all your patients. Even if they're not, they're your patient's son, niece, aunt, etc. I couldn't go to the grocery store sometimes because people would stop me and ask for bloodwork results or refills. People regularly asked for prescriptions for family members, or would text pictures of rashes to my private number given out in a social context. 

It's also just a low numbers game. 2000 people, most out of age range, sexual orienting, in relationships. I think were all of 3 available people, and 2 of them were my direct supervisors. So...

 

[MasterDoc]

29 minutes ago, Sisushi said:

I couldn't go to the grocery store sometimes because people would stop me and ask for bloodwork results or refills. People regularly asked for prescriptions for family members, or would text pictures of rashes to my private number given out in a social context.

Well, this is just out right rude!