From Washington State's Apple Country to the streets of Baltimore. Deep in the Louisiana bayous to the beaches of the South Pacific. From New York City to the small towns along the Tex-Mex border. In short, NHSC clinics and clinicians could be found almost everywhere - maybe even in your hometown.
Any locale that is classified as a health professional shortage area (HPSA) can be an NHSC community. These HPSAs are located throughout the United States, the District of Columbia, and U.S. Trust Territories and Outlying Areas.
Whether at rural or urban sites, NHSC clinicians describe meaningful experiences with the communities they serve.
Rural Practices in the NHSC
Many NHSC clinicians choose a rural practice because of the quality of life it offers. In fact, 60 percent of NHSC clinicians work in rural settings. The towns are usually small. There is a strong sense of community, and NHSC health professionals are typically admired and trusted as respected members. According to Student Doctor, the official journal of the Student Osteopathic Medical Association, income in a rural practice is equivalent to what you would earn in other areas, and rural practitioners typically work longer hours. On the other hand, everything from groceries to entertainment to housing costs less than in a larger city.
Many of the reported disadvantages of rural life turn out to be more myth than truth. For example, some people consider a rural practice to be less professionally satisfying because of a lack of variety in patient problems and pathologies. But Janet Sidebottom, a nurse practitioner (NP) and NHSC Loan Repayor practicing in rural Missouri, has not found this to be the case. "We have found pathologies for all sorts of things," she says. Other widely held beliefs are that there is a lack of access to advanced medical equipment, and that these communities may present professional isolation. But that, too, is not necessarily true. "I get invited to all kinds of professional events," says Sidebottom. "And there are a lot of outreach programs that come to us."
Michael Gregory, another NP and former NHSC Scholar, practicing in rural Washington State, agrees. "With more interest on State levels," says Gregory, "there is more outreach to both urban and rural sites. And telemedicine is helping." Gregory also notes that they have developed a network of specialists they can call on with little notice. "We can fax colleagues at other sites and they'll get back to us right away."
A rural setting can mean less privacy during nonworking hours. How you respond to that depends on your personal perspective. Robert Floss, M.D., practices in Hampton, Arkansas, and finds that the intimate community life of this rural town is profoundly rewarding. "My wife is originally from a small town," he explains. "People who've never been exposed to small-town life don't know what they're missing. You learn to be a part of the community, not just a member. You become a vital component to the entire community."
Urban Clinics and the NHSC
As with rural practices, urban practices provide a deep sense of satisfaction through helping the underserved. Among NHSC clinicians, 40 percent work in urban settings. City life offers unique benefits for families and individuals, including a wide range of cultural and educational opportunities. Also, there tends to be a variety of places to live a reasonable distance away from urban sites, if that is your preference.
There is likely to be a broader base of social and professional contacts, and a city setting clearly offers a more convenient professional support system. Accessible, available laboratories and local specialists for patient consultation or referral are less common in rural settings. Likewise, hours of operation are often shorter in urban practices than in rural settings.
The most obvious challenges of an urban practice are congestion, noise, traffic, and crime, which are simply part of city life. Some contend that it's harder to get paid for services rendered in an inner city because patients may lack adequate financial resources and it may be difficult to collect third party payment. In fact, says Laura Gushue, a dentist and former NHSC Loan Repayor, sometimes it's easier to get compensation in the inner city. "We're city-subsidized," explains Dr. Gushue, who began with and still practices with the Cincinnati Health Department. "Patients only have to pay an average of 2 dollars for services rendered. The homeless are federally subsidized through a grant program. We also have donated dental services, where dentists offer work at no charge."
Inner cities tend to have larger homeless populations, and working with this population may make some clinicians uncomfortable. Gushue understands this concern; initially, she was worried about working with the homeless. "I didn't know what to expect," she says. After establishing herself, however, Gushue found her experience with the homeless to be particularly rewarding-for the patients and for herself.