Everyone knows there is one rule in real estate. Whether you want to build a skyscraper or locate a rheumatology office, that rule is location, location, location. But what if that location is rural? Then what?
Rheumatologists seeking to open their doors in a rural or underserved area need to approach their site selection for a physical office with the specific needs of their clientele in mind, says Wendy Welch, PhD, director of the Graduate Medical Education Consortium of Southwest Virginia, which looks to recruit and retain local doctors in its rural corner of the state.
“Think about the donut hole in rural population,” Dr. Welch says in an email interview with The Rheumatologist. “Where is the aging population likely to stick? … If you chase the younger crowd, you will have a revolving population.”
Art & Anecdotes
Dr. Welch, editor of Public Health in Appalachia, a rural-medicine textbook, says that locating a rural practice is more art than science, because anecdotal evidence for success can be just as predictive as data. For example, some practitioners think that locating in a region’s most centralized city may be the most effective way to reach the most people. However, Dr. Welch suggests that a major driver to office traffic in rural areas is proximity to a supermarket, rather than a highway.
“People in small towns go to the doctor where the grocery store is, and the city is more a place to avoid than a day out, especially when you need care,” she says, adding, “if you’re near a city, you’re near competition. Whereas if you’re near a grocery store, you’re probably the only specialist in your community and an entire county’s population keeps walking past you.”
Although rheumatology is not typically a specialty focused on emergencies, Dr. Welch notes that in snowstorms and bad weather events, roads to grocery stores and the surrounding area are often cleared and repaired first, to provide access.
Support Staff
Another key factor in where to build a rural practice is where to hire from. Always look to hire local professionals for support staff, especially for those positions that are patient-facing, Dr. Welch says.
“Front-line staff are the key to moving from ‘the incomer’ to ‘our doctor,’” she says. “Choose someone as kind as [they are] efficient, whose accent reflects a welcoming voice. … People are more comfortable with what they know—the voice patterns they recognize, the last names they grew up around. [It’s] the instant trust factor a trusted face gets you, immediate buy-in because you’re with her, or him—or more correctly, they are with you.”
Tech Talk
Rheumatologists looking to open a rural practice need to realize there are also technologies that can help mitigate the distance from patients, as well. When choosing an office location, they should consider the impact of telemedicine, Dr. Welch says.
“The population base may be small, but with one specialist in a rural area, [the practice] will be overcrowded with patients,” she adds. “Telemedicine does help on a daily basis, and it is invaluable on nights and weekends.”
Culture Shock
Dr. Welch, who teaches a freshman-level cultural geography course that includes site selection, says the physical location of an office is always important in a rural area, but “cultural competency” is paramount to making the office a success.
Being a rheumatologist in a rural area means knowing “how to discern what ‘I’ll pray about it’ means. Or how to talk to an elderly patient with respect. Or never talking politics.”
“If you come in with a good attitude and your first few patients learn to trust you, [that’s priceless.] You can’t buy that kind of advertising,” she says. “They’ll tell others in the community and their churches, and your practice will overflow. By the same token, blow a cultural moment, and you will sink. … Understand the economic challenges and the strong privacy issues that go with those for many rural patients. There are many cultural competencies in rural places that divide on class, education, tradition and religion. These competencies can make or break small-town doctors.”
Richard Quinn is a freelance writer in New Jersey.
