Working in Rural Primary Care and Love It!

[FullGlass, BSN, MSN, NP]

New grad AGPCNP here, made it past first 6 months in a rural FQHC. While it has been very stressful as a new grad NP, I am very happy with my first job (and my employer and patients are happy with me).

I was so scared when I started - afraid of missing something important, afraid of a misdiagnosis, prescribing wrong treatment, asking too many questions of the other providers, etc. It was a struggle to learn the EHR, complete charting, stay on schedule. Every night I would go home exhausted, a complete zombie. Sometimes I cried, feeling so stupid and wondering if I could ever learn enough. My classmates have said they felt the same way.

Six months in, it is getting a lot better. Yes, I am still stressed, but much less so. I have a full patient load (18 patients a day) and normally complete my charting promptly by working 1 to 1.5 hours extra each evening and a couple of hours on the weekend. My knowledge and confidence have improved greatly. Obviously, there is a long way to go on the knowledge front and learning will be a life-long endeavor.

As for working in a rural area, it has been an adjustment and of course, there are advantages and disadvantages. Some on this forum have accused me of being a pollyanna. Maybe, but every one of us can control our expectations and attitudes.

Advantages

1. Areas with a provider shortage are more willing to consider new grads and they are also willing to invest in training. My initial patient load was 6 patients a day and that increased to 18 patients over 5 months, and I had control over the rate of increase.

2. Areas with a provider shortage generally have a low cost of living and pay MORE than cities like San Diego, L.A., San Francisco. For example, my first year pay is $124,000. I am renting a little 2BR 2BA house with a yard and a nice view for $750 and could easily have a roommate, making my rent $325. A house like that in San Diego would cost at least $2,000 a month and I'd be making $100K to $110K, significantly less. The average 1 BR apt rents for $1500 a month in San Diego, $3000 a month in San Francisco/Silicon Valley

3. Areas with a provider shortage are eligible for state and federal loan repayment and for loan forgiveness.

4. Areas with a provider shortage will bend over backwards to retain you and provide good working conditions. The other providers will truly want to help you succeed.

5. Patients really appreciate you. Patients in such areas are thrilled to have a permanent provider, after going through years of no provider or a revolving door of locums. You will be an important and visible member of the community.

5. NO TRAFFIC!!! In addition, I can easily walk to the clinic. After living in San Diego, Los Angeles, Washington DC metro, and San Francisco/Silicon Valley, it is such a relief to not worry about fighting traffic.

6. NO CROWDS!!! I was shocked that when I go to the Post Office, I usually have no wait.

7. Beautiful facility. Our clinic is only 6 years old, so it is large and state of the art for primary care. It is also very cute, with architecture reminiscent of a ski chalet, surrounded by evergreen trees. My office window has a view of a cute little house with dogs, pigs, and goats.

8. Integrated services. Many FQHCs in California have primary care, dental care, and mental health under one roof, as we do, making it easy to do warm hand-offs and coordinate care.

9. Easy access to outdoor activities. If you like hiking, camping, fishing, hunting, golfing, horseback riding, gardening, skiing (downhill and cross country), rafting, kayaking, boating, and golfing, then rural areas provide many wonderful outdoor recreation opportunities. My backyard has a lovely view of mountains and there are several state and national parks nearby with beautiful scenery. Our town is on the Pacific Crest Trail and people come from all over the world to hike the trail.

10. Many rural areas and small towns are within easy reach of larger towns and cities. For example, my town is only 50 miles (and a fast 50 minute drive) to a city of 100,000 people, with flights to San Francisco and Los Angeles. We have a clinic that is a 20 minute drive from Klamath Falls, which is a lovely city that also has a beautiful hospital. Sacramento, Reno, and Tahoe is a 3 - 3.5 hour drive, Medford a 2.5 hour drive, etc. Many people who live in large cities spend the same amount of time commuting to/from work every day.

11. Satisfaction of providing public service and "giving back."

12. Some really cool stuff, like treating patients who were doing cattle round ups and fell off their horse. :)

Disadvantages

1. Entertainment options like restaurants, clubs, theaters are limited.

2. Shopping is limited - Amazon will be your friend and plan on periodic trips to the nearest city for better shopping.

3. Socializing - people tend to be more friendly and there are lots of community activities, but there are just fewer people one can meet. However, in my town there are lots of educated people as we have the clinic, the hospital, the Park Service, and some larger businesses, farms, and ranches. The nearest large town is also the county seat, so there are lots of professionals there and there is also a university town just 1.5 hours away.

4. Cell phone and internet can be spotty.

5. In a small town, everyone knows who you are, so one must be on their best behavior in public, and that includes social media.

6. Lack of specialists can be incredibly frustrating. Inland California has a terrible shortage of specialists, so it is difficult to find one and then there can be very long waits for referrals; patients may have to travel long distances.

7. There is a lot of poverty and it can be heartbreaking trying to help patients who don't have insurance or even if they do, live in such poverty it is difficult for them to lead a healthy life.

Conclusion

Rural areas are not for everyone, but after a lifetime of living in big cities, I am happy with my choice. Why? Beautiful mountain scenery, forests, crisp clean mountain air, good onboarding for a new grad at a reasonable pace, very nice vibe at my clinic with providers truly helping each other, a great MA, nice appreciative patients (well, 99% of them), nice physical facility, low cost of living, no traffic, lots of outdoor activities. Worst case, I can stay here for 2 years, get solid experience, and then move back to a city.

A word to NP students or new grads reading this: this forum caused me a great deal of angst. The posts here made me feel like I had to be at 100% right out of the gate. Not true. The MDs and NPs here told me they expected a new grad to know NOTHING and to ask a lot of questions. They are always happy to answer questions and come see my patients if needed.

PLEASE consider working in a city, small town, or rural area with high need! There are many, many such areas in the U.S., from cities of 1 million people all the way to rural areas. You don't have to live in such an area forever, but you can build up your bank account, pay down debt, and get some great experience, while performing an important public service.

Feel free to ask me any questions.

[Spadeforce]

no doubt I plan on moving to some town deemed undesirable after done with residency to do ER work. Many small shops pay 300+ an hour in really "icky" places with the norm being low to mid 200s for small/medium cities. Not sure what it is but the coast seems to be a magnet for docs and it seems that notion holds true for NPs also.

cities are overrated and luckily for us most people love cities

Not sure I plan on going to cali though. that tax is too high lol

[Phoebelu]

I am happy for you. What state are you in? I tried to find a FQHC for a long time after graduating, and because I am like you, an AGNP, they would not consider me since I didn't see children. How did you get around that issue?

[Oldmahubbard]

I know many people here gave you a hassle, and I am really glad to see it is working out well!

[FullGlass, BSN, MSN, NP]

I'm in California and also got offers in New Mexico and Nevada, and great interest from Oregon, Hawaii, Arizona, Montana, Wyoming. The Western states have a severe shortage of primary care providers and mental health professionals outside of the main cities. Clinics that have multiple providers will often consider an AGNP - our FQHC clinic has 5 providers and we have other clinics too, so not everyone has to be an FNP. In addition, I got offers from specialties like neurology, cardiology, occupational health, hospice, and sleep medicine where almost all the patients will be adults.

[AnnieNP, MSN, NP]

I'm really happy for you!!!!

[Tony1790, BSN, MSN, NP]

I like your post, honest, realistic with pro/con's thrown in, love it, nice.....

[bbcewalters, NP]

So Happy for you! I always enjoy reading your posts. Also the biggest factor is always attitude. If you think something is terrible it will be and vice versa....

Bobbi

[Cococure]

So happy for you and thanks for providing and honest feedback 6 months into your new role. I am very excited and anxious about graduating May 2019 and it is encouraging to read your posts.

Good luck happy you found your niche!

[SVO3333]

It's been a while but are you still in California? Also did you apply for Federal Loan Repayment after you got the job or prior? Thank you and hope you are doing well! 

[Freckledkorican, MSN, APRN]

You hit the jackpot! Bravo!