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    Cityscapes and Country Cool: Finding value in changing practice environments


    Remember the folk tale about the city mouse and the country mouse that switch places so they could experience a different way of life? As a locum tenens professional, you have the chance to immerse yourself in the hustle and bustle of a metropolis one week and the quiet of country life the next. Whether you choose to accept an opportunity at a Level I trauma center or the only solo practice in town, you can discover communities with distinctly different clinical environments, populations, and cultural and recreational outlets.

    How can you tap into the best of both worlds? Read on as two locum tenens physicians, a certified registered nurse anesthetist (CRNA), and a staffing company executive share their insights on finding value—and a welcome change of pace—in different practice locales.


    "In the early years of the locum tenens industry," says Chuck Harris, president of Harris Medical Associates, LLC, based in Suwanee, Georgia, "the greatest percentage of opportunities was in rural areas. Today, demand has shifted to both markets. With the movement toward larger groups, hospital-owned community facilities, hospitalists, and a team-centered approach to patient management, particularly in urban areas, the need for primary care physicians, mid-levels, nurses, and ancillary providers has created a stronger case for contingent staffing services."

    The market
    He continues, "Currently, there is a great need for CRNAs and primary care physicians in both urban and rural environments. Internists, in particular, and orthopedic and general surgeons, are in high demand in rural areas. Clients in urban regions are also looking for neurologists, gastroenterologists, urologists, and ear-nose-throat specialists."

    No matter the specialty, however, opportunities are often longer in rural areas and shorter in urban regions, with government contracts covering a longer term than commercial ones. Mr. Harris adds, "Residents are often geared to longer-term contracts, while mid-lifers typically accept weekend coverage within driving distance of their homes or have the flexibility to provide services a week or two at a time over vacations. Those nearing retirement often choose longer-term opportunities, as well."

    The types of practice environments are as varied as need and length. Urban facilities and practices most likely to request locum tenens services are large groups, emergency departments, integrated healthcare delivery systems, and community facilities. Opportunities in rural settings include those at critical care access facilities, rural health clinics, hospitals, and single/small specialty groups.

    The challenges
    "As a general rule, most locum tenens physicians tend to gravitate toward one type of environment," explains Mr. Harris, "but many will consider either locale if it provides the opportunity to stay within driving distance of home." He adds, "While the Number One factor for taking a contract is geography, flexibility (based on specific lifestyle emphasis and point in career) is also a strong consideration."

    Each setting offers professionals the chance to stretch their skills. "There is more of a 'turn-style' approach to medicine in cities, whereas rural medicine has the physician/patient encounter running longer and operating on a more personal level," observes Mr. Harris. "Rural providers must call on all their clinical skills and be able to function autonomously without the immediate backup of specialists common in larger urban practices."