What will lure you to practice in a certain city/town?

[Guest ashylips]

Hi!

I'm a first year undergraduate student asking this general question to med students for my poli sci term paper.

 

First thing that comes to mind: what is the deciding factor for you when you're going to be deciding where to practice/internship/residency? (e.g. cash incentives, schools for children, housing, population size, pollution levels, research opportunities, entertainment, etc. If closeness to family/friends is important, what area is that?)

 

One word answers are fine!

Thanks

[Guest gucio93]

Hi there!

The biggest deciding factor for me would be whether or not my husband had a reasonably high potential for getting a job there. He is a biochemist and thus the city we would choose would very likely have to be within a reasonable distance to a bigger metropolis. In addition, since we also have a child, we would be looking for a city that is fairly "safe" (i.e. low crime rates) and located in a nicely landscaped geographic area, as we all love the outdoors. The rest is of lesser consequence.

[Guest UWOMED2005]

There was a great article in the Globe & Mail this past July or August on this topic. It was a letter from a graduating medical student published on the final page of the A section ("Facts & Arguments" I think) Check it out - it should be a good resource. Sorry I can't be more specific than that.

 

As for myself, my stance is similar to that of the author of the article. Basically, and element of what he argued was that the day of the grand old "country doctor" died with the advent of two-career marriages. You see, for myself, I eventually wanted to get married and most likely I will be looking for someone with the same dreams and aspirations as myself, meaning she will probably educated and career-oriented. Problem is, there are fewer opportunities for employment for such people in rural settings. And if I'm not married by the time I graduate (highly likely considering how little time I have to meet anyone) heading to a small town would be dating-suicide: as a physician you are absolutely 100% not allowed to date patients, and in small towns it is a common occurrence for everyone to be your patient.

 

A friend of mine at Western has the ideal situation in this area. He and his girlfriend are both from small towns and as she's in dentistry, they have talked about one day moving to a small town and setting up the local dental and medical practices. Unfortunately, not all of us are so lucky. Some of us end up falling in love with M.Sc. and PhD students/grads, and while Dryden ON, Eganville ON, and New Glasgow NS are all beautiful towns, they're not exactly hotbeds of cutting edge academic research.

 

Pity - from the 4th year students I've spoken to there seems to be a general consensus that rural family medicine is one of the most interesting fields by far. Without specialists, you are guaranteed to have the opportunity to do a wide variety of procedures, and you are guaranteed patients.

 

If I met and fell in love with someone who was happy moving to a smaller centre, I'd probably consider it (though I really am a city boy.) Unfortunately, I see that as unlikely.

[Guest Ian Wong]

Diverse population and culture, attractiveness of the city and outlying areas, weather, job availability, working hours, salary, minimal hospital and bureaucratic entanglements, family and friends.

 

I think the reasons that a given doctor would work in a particular area are the same as why any other human being would work there. The job has to be available and pay well. The city should be large enough to meet your needs without being too stiflingly large (ie. large enough to not be boring, and not so large that parking sucks!) The weather should fit the outdoor activities you like to do. It's great if you already have friends and family in the area, instead of having to start from scratch.

 

I actually was interviewed by a classmate regarding the topic of rural medicine (she's trying to get the CBC to broadcast her documentary sometime, let's see if that ever happens), and when she asked me if I'd ever considered going up north, I said no. At least, not for the long term. I could definately go up there as a locum, but as for setting up a permanent practice up there, forget it.

 

Up north, in a tiny city, I lose all the cultural amenities that I'm used to. No Chinese food, no Chinese language, heck, no other Chinese people at all! As a city boy, I like having the freedom to do different things. Yesterday I went shopping at Costco. The day before I had take-out Indian food. The day before that, went rollerblading and had sushi for lunch. The diversity that I've taken for granted and grown accustomed to just isn't available in Fort St. Upthere, population 10,000. I would feel like a complete outsider, without any of the ties that I'm used to from by background. And I don't think I would adjust well to that new environment; it'd simply be too big of a shock.

 

As a result, I think the current situation of medical schools is doomed to failure. It's very difficult to accept an applicant whose lived his/her entire life in the city, and then try to "convert" them to a rural lifestyle if they aren't accustomed to it or don't want it by restricting salaries in the city, or trying other financial incentives to bring doctors out into the remote rural communities.

 

We need to look futher at the kinds of applicants we are accepting, and go from there.

 

Ian

UBC, Med 3

[Guest Akane200]

I have to echo what Ian said about the conveniences of the large cities. <!--EZCODE ITALIC START--> Akane is an urban girl<!--EZCODE ITALIC END--> This question also depends on what you would define a city. I sometimes laugh at what some of my friends would refer to as "cities" (but I'm from TO which makes it alright since everyone expects torontonians to be egocentric anyways :rollin ).

 

I grew up in Toronto (which I like very much), and I can't ever imagine leaving that to live in a small town. Let's see, would there be a Banana Republic there? :lol I can live in the suburbs, but those don't count as small towns either. But seriously, I don't think that small towns have the amount of choice and variety in services and activities, or even people that exists in the city.

 

The other reason is cultural (which is one of the more decisive factors). I must have my real chinese food, noodle shops, grocery stores where I can buy things like good "bok choy", sushi places, etc. Even if you paid me a lot, I simply can't see myself living happily without this stuff. Like Ian said, there aren't a lot (or any in some cases) Chinese people out in the rural areas, which may make it a less comfortable situation for me.

 

In addition, while rural docs get to do "wide variety" of procedures due to the lack of specialists in those areas (which I wonder if that is good or not...), I also want to point out that in the city, you are likely to see a wider variety of cases as well as the more complex cases just due to the fact that there are more people in the city. Also, many cases are sent from the rural areas into the city. Where there are fewer doctors, you're probably on call more often too.

[Guest ashylips]

Wow guys, thanks for the detailed responses!

 

I'm from Windsor, Ont. and attending the University of Windsor. For those of you who have never heard of Windsor, it's a border city w/ Detroit (all those beautiful Detroit skyline pics are from the Canadian side) and a population size of 200,000+ without including the surrounding towns. It is by far not a rural town, but by the amount of doctors we have, our standards for health care have sunk dangerously low.

 

To give you some insight, Windsor has recently been granted a satellite medical school w/ Western. We are altogether short 250+ doctors and have one of the highest rates of cancer. People have to wait 6 months to one year for routine appointments and visits to specialists are only granted to those in dire need (some cannot even see a specialist!). Some travel to London or Toronto (4 hours away) or even to the United States for health care that they cannot receive in Windsor. The provincial government pays dearly for those U.S. hospital bills.

 

I think that Windsor is "in the middle" in so many aspects that it is often overlooked by physicians and politicians. Diversity and culture is not a problem (I myself am an Asian Canadian satisfied w/ the representation in the city), many ppl. live in Windsor but commute to the States (obviously, better pay and opportunities just a 5-minute drive away), you'd think that crime from Detroit might spill over but we are completely bland/lacking in our crime rate, and we are just far enough south of London (2 hrs.) and other bigger cities to be somewhat isolated from the rest of Southwestern Ontario.

 

I'm writing this paper w/ Windsor in mind. It's heartbreaking to see so many of my family and friends desperate for adequate health care (for a family w/ heart problems and only 4 cardiologists in the city) and waiting periods of sometimes over a year. The problem is multi-faceted, yet somehow I wish that there was something that I could do to solve the mystery that a lot of communities would like to unlock: how to get more doctors to practice in their city.

 

P.S. Sorry for the length! But I did get a great idea from your responses. Windsor is definitely lacking in its opportunity for academic research. I might focus on a recommendation to improve that area.