Pros and Cons of Rural Practice

By Trevor Jacobson, MD

My name is Trevor Jacobson- I’ve been asked to write a post on rural family practice.  I went to medical school at the University of Utah and stayed for family medicine residency (2009-2012) as well. I did not do any special training or fellowships after or during residency. My first job was locums on the island of Maui. It was a good job in a great location. I was used as a same day appointment physician which ended up being a lot like an urgent care practice. After completing my contract, I left for a rare private practice positions at a clinic in Salt Lake. It quickly became apparent that it was not going to work there, with half the partners wanting another doc, and the others not. I soon found another job working for Onsite Care with Donna Milovetz as the private Salt Lake City municipal workers doctor. It was a lot of preventive and low acuity visits. It was again a great job, but less challenging.  After about a year, the administrator for the Bear Lake Memorial Hospital approached me with my current job in rural Idaho, close to beautiful Bear Lake.  After working here for 8 months, this is what I think…..

Living in rural Idaho is the biggest pro, and the biggest con. It is a slow pace of life here. It is a very simple life, in wide open space. I bought a large country home with acres of land for dirt cheap. I have started a small farm with cows, chickens, pigs, orchard and garden. I don’t know the first thing about a farm, but why not, right? My kids are encouraged to roam free and lose themselves, and it’s safe. Camping, hunting, fishing, boating, skiing, wake boarding are even more accessible than in Salt Lake….but I miss Snowbird, I miss bikram yoga, I miss Costco, restaurants, and concerts. Logan is just over an hour away, Salt Lake 2.5 hours away.

The practice itself is amazing. I cover the hospital one week out of the month, and average about 2-3 patients to round on. Some weeks I’ve gone without an admission. I was never a fan of hospital medicine, but this has been a good experience. We do not take care of ICU patients, its better care at a larger facility, so we transfer them out.

I cover the hospital ER about 3-5 times a month. The shifts are 24 hours, you see an average of 6 patients a shift, only 1-2 of which are actually emergencies. The pay is good and the call is from home but some docs stay at the hospital.

My clinic is 4 days a week, 8-5 with ½ hour appointment spots for now until I get busier. I have zero pressure to fill my schedule, and they let me set my hours which is incredible. Some of the FP’s here do OB, c-sections, and scopes but I choose not to. Most specialist are over an hour away, so I manage a lot of illnesses that I couldn’t do in the city. I can still refer to specialist if I must, at Logan or Pocatello. Patients are very forgiving and grateful.

My job is not like most other rural positions. The administrator is awesome. We have a full time orthopedic surgeon, general surgeon, part time OBGYN, visiting Urologist, ENT, and podiatrist. We have a CT scanner, a mobile MRI and mammogram machine.  The staff is great and experienced.

I have enjoyed all the jobs I have had up to this point. Rural practice is more challenging, which isn’t necessarily a bad thing, and I make double what I had at any of the other jobs. Plus at the end of my 5 year contract, they pay off all my student loans.

I’ve had multiple different jobs in my first few years outside of residency, but I finally found the one that makes me happiest.

Trevor Jacobson, MD is a graduate of the family Medicine Residency program at the University of Utah, School of Medicine.

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