Practicing in Rural Settings Offers Slower Pace, Personal Satisfaction for Many Rheumatologists

“I was the only rheumatologist for about 15 counties when I started in private practice,” says Dr. Moeller. “It is certainly easier to leave a fellowship if you have four or five senior partners down the hall you can look to for advice. It took the better part of three years before I was able to feel completely comfortable in my role as the only rheumatologist for miles around.”

At the time, the major resource available to rural physicians was the telephone and contacts made during residency and fellowships. All those interviewed for this article noted the great help and comfort it was to have their professors and mentors in the urban areas at the other end of a telephone.

Karen Kolba, MD, is a rheumatologist in a solo practice in Santa Maria, Calif. She found that being active in the ACR was one way to lessen the isolation.

“I took refuge in the ACR,” she says. “Committees and leadership positions were a way to stay in touch with the outside world. I also went to the annual meeting and some of the smaller ones to stay connected.”

Most of the rheumatologists who made the switch to rural settings also missed the luxury of having large medical libraries to fall back on. Dr. Kolba noted that she probably subscribed to more specialty journals at her office than were available at local hospitals.

Internet Bringing Changes

However, many of these concerns have changed over the years because of the availability of the Internet. Websites such as UpToDate.com give easy access to the latest research and experts in many fields. The availability of journals and even remote access to databases has opened up the equivalent of a medical library on the desktop. E-mail that can be answered at a person’s convenience has replaced phone tag when one practitioner wants to bounce something off of another.

Dr. Ziegenbein noted that interactions with her colleagues at Marshfield have always been an important aspect of her practice, independent of the mode used. However, she finds video conferencing especially exciting because it allows her to still become involved in debating clinical options in complex cases.

All four physicians agree that working in a rural environment is not for everyone.

Understanding What “Rural” Means

“A person thinking about working outside the city needs to understand exactly what ‘rural’ means,” says Dr. Ziegenbein. “There will be fewer amenities, less shopping, but a more serene atmosphere.”