On 6/11/12 I officially enter my LAST year of residency and am finally starting to see the light of a very long and arduous tunnel. My senior resident colleagues and I are just now starting to be inundated with emails and phone calls from recruiters and practice representatives from across the nation. As the Baby Boomers move into retirement, and along with them the physicians of the same generation, the demand for new recruits continues to grow. As is true of real estate, for many of us it’s all about location, location, location! Positions in coveted downtown city locations are never short of applicants but beyond the cityscape and adjacent suburbia lies an ever expanding need for medical professionals.

The Washington Post recently posted the above image generated with esri software that geographically identifies areas of increasing medical need. Areas that are dark orange are already in great need of medical providers and they are likely to continue to grow in dimension.

Having grown up in a suburb of Seattle (Kent, WA), I don’t think I would have given rural medicine any consideration prior to medical school which I completed at Oregon Health & Science University in Portland, OR. OHSU prides itself in fostering a love of primary care among its students as well as an appreciation for rural medicine. During my time there I completed 4 rural rotations in primary care, family medicine, neurology and surgery lasting approximately 8 weeks each.

I was required to complete a community project in my primary care rotation in Coos Bay, OR. I elected to research the issue of rural physician shortage in terms of physician recruitment and retention. I had the opportunity to interview local recruiters as well as rural physicians of multiple specialties. I also conducted a survey of the 3rd and 4th year medical students regarding their experiences with and interest in rural medicine. I then compiled this data into a written manuscript: Recruiting and Retaining Physicians in Coos Bay: Assessment of Medical Student Interest in Rural Medicine and Rural Physician Perspectives on Their Practice. I later presented this data at the 25th Annual Oregon Rural Health Conference. My presentation can be found here.

I discovered that there are a lot of benefits to working rural areas including making a difference for an underserved population, becoming part of a “close-knit” community and having a larger scope of practice. Fringe benefits include outdoor activities, simpler lifestyle, lower cost of living and potential student loan repayment.

Some of the more challenging aspects of working in a rural area are cultural and political differences. It seems that the more diverse and populated communities are, the more liberal and tolerant they are as well. Rural America is more homogenous in character and conservative in opinion. White Anglo-Saxon Protestant (WASP) physicians tend to find a home away from home more easily, especially when they share the same values as the communities they enter. Those of us who are different often feel like outsiders who are simply extended cordial hospitality with an arms-length handshake. The vast difference between city and rural amenities can also contribute to culture shock, homesickness and isolation.

My partner and I are willing to consider rural locations among our opportunities. Both of us have moved extensively, Patrick more than I, and we enjoy the adventure of new experiences and making new friends. The issues I foresee being problematic pertain to the differences I alluded to: I am a partnered gay father in addition to being an OB/GYN resident physician; my personal life cannot be separated from my professional life. Patrick and I have been committed to each other for the past 10 years. I have been a father even longer. I feel that it is a travesty that we live in the 21st century yet continue to be treated as a second class citizens. Because our relationship is not recognized in the majority of States we suffer mentally and financially. Although more and more insurance companies are choosing to include same-sex partners, many do not. I have worked too long and too hard to accept employment with a group that will not allow me to insure my family.

Another issue is abortion. The Republican-lead War on Women is in full force and a record number of anti-choice ballots continue to make their way through state and federal legislatures. We are rapidly returning to the pre-Roe Vs. Wade era. Some sobering statistics are the following:

• Approximately 1/3 of women require an abortion procedure over their lifetime.
• Over 90% of OB/GYNs have had patients request abortion services.
• ONLY 14% of OB/GYN providers provide them.

While this may be great news for the anti-choice audience, women AND children are already suffering much and may be soon forced to suffer more. The U.S. foster care system is overflowing with abused, neglected and unwanted children. Shall we increase their numbers? Women have many deeply personal reasons for seeking abortion. Sometimes they are truly in danger of dying because the pregnancy is too great a strain on their pre-existing medical conditions. Other times they simply cannot afford yet another mouth to feed. Although abortion access isn’t really one of my soap boxes, I cannot consider myself a defender of social justice and turn a blind eye to this dilemma. Abortion is legal in this country and is a part of comprehensive OB/GYN practice. I cannot ethically permit my scope of practice to be limited by religiously or politically motivated restrictive work covenants.

And then there are my professional interests which include issues pertaining to the LGBTQI (lesbian, gay, bisexual, transgender / transsexual, queer / questioning, intersex) communities, Mayer-Rokitansky-Kuster-Hauser syndrome (Mullerian anomalies) and polycystic ovarian syndrome (PCOS). The majority of gender and sexual minority patients receive sub-optimal and inadequate care. And although PCOS affects around 7-8% of women it is often the elephant in the exam room that is repetitively ignored. I must also make myself available to these underserved populations.

One recruiter wrote to tell me that “the 232 clients my colleagues and I are working with nationwide will not be able to provide you with all of those items. If they are really non-negotiable factors, I will not be able to assist you with your search.” Fortunately there are many other recruiters that do not share his lack of vision.

Although my personal life and professional ambition may “offend” some I am confident that I will find the right place for me. The map is wide open and opportunity calls.