Rural Medicine Dreams--Catching Some Flack

Greetings all–
I am making the transition of working in outpatient mental health to preparing for application to a DO program. I live in rural western PA and love it. After growing up outside of Buffalo NY I find that the country suits me just fine. There are some draw backs, but I am 90 min from Pittsburgh, 90 min from Cleveland and 2 hr from Buffalo. So when I need a bit of stimulation (shows, shopping, etc) I head for the cities.
As I am discussing my hopes of becoming a dr, I am liking the idea of setting up shop in my area. We are always experiencing a shortage of family practice drs here and really need some pediatricians. Many people are driving an hour to get to health care providers (downtown Erie, PA)
Some people that I speak with (family, friends) say that there is no money in family practice and that I should consider more of a specialty. I guess because I have done family therapy for so long, I have enjoyed taking care of families. I am not in this for the money, so to speak, but am worried that I will not make enough to pay back my loans. I do have a friend in her third year of a DO program that offered to allow me in to her practice when all is said and done and she enjoys rural medicine as well. I do have access to about 5 hospitals within 1/2 hr driving distance, but they are small. I am not looking for a glamourous setting, but am wanting to serve my community and am settled in here.
Perhaps some of the wise people here could answer a few questions…
What is the average student loan debt when you are done and ready to practice?
What are the benefits of working in a rural area?
Thanks so much!
Erica L

Hi Anastasiasmom,
One option that you may want to consider is the NHSC at
They will pay for your medical education: tuition, fees, books, housing, food…
For every year they pay for school, you must serve in an underserved area, which could be in a rural or an urban area - after your residency.
The scholarship is competitive; 1800 people applied this year for some 200-300 spots. I have my interview in Boston tomorrow!
Good luck.

Does your state have a family practice/rural medicine scholarship/loan payback program?

My understanding is that the AV debt for med students is $200,000. Like you, money isn’t my motivation. Check out the website BACMEDIC sent, its a great program. (BTW, Good luck on your interview, BACMEDIC!) Good luck,
Kathy R

With financial aid, many schools’ average debt is more on the order of 80-90K with a full financial aid package. That is, if your family isn’t being asked to make a contribution. Your mileage will vary substantially depending on the school, the cost, scholarships, whether you have money in the bank or own your home, whether your school wants to factor in your parents income and assets (yep! even OPMs–freakin incredible) and so on.

The benefits of working in a rural area?

It sounds like you already know them.

From a financial point of view, if there’s a lower salary there’s also usually a lower cost of living.

And there is nothing stopping you from becoming a specialist who works in a rural area, either. Rural folks need surgeons and anesthesiologists–just ask OMD, up there in the woods of New Hampshire, putting the folks of New Hampshire and Vermont to sleep so other people can cut em up. And emergency docs. And all kinds of other doctors too. (Including straight up internal medicine, often a bit better compensated than family practice.) Family practice is not the only option; but there’s no reason to think that family practice is closed off to you for financial reasons. You’re making less than a doctor would make now, right? So, if you’re OK with making what you’re making now, and you want to be a doctor, then add the debt payments of a 200K loan over 30 years (worst case debt, not actually the average); figure a variable rate loan with a conservative estimate of an average of 6% interest (a little more than twice the current rate); and then figure out how much money you will need to make in the worst case. I would bet you’d be fine.



I tried the link and it will not allow me to enter that site for some reason. I will look around and see what I can find in terms of this type of program. We do have one area that is considered underserved–about 20 minutes from here–and I could apply to work there. It is connected with the Conneaut Valley Family Health Clinic /Meadville Medical Center.

I found a neat link when doing a search this evening about rural medicine:
Thanks to all who wrote–I have some more ideas now on what to research.

if you go to AAFP’s website and explore the student and residents sections, you’ll probably find some stuff on rural medicine. (I haven’t visited the site in a while but I recall coming across something.)
Nat’l Health Services Corps does the scholarships for med students as already discussed. What a lot of people don’t know is that they also do a loan payback program. It works like this: as you are finishing your residency, you can consult a listing at NHSC of jobs in underserved areas (these are urban or inner-city). The jobs supposedly pay “competitively” for the area, but I haven’t looked into this enough to know if that’s really true. You take the job for a two-year commitment and get $25K per year of loan payback. You can work for up to four years in the position, which would be $100K of loan payback. (I THINK. Please don’t quote me on this because I haven’t read up on it lately, but that’s what I recall from talking to a NHSC recruiter at a residency fair last year.)
People have mentioned that states often have loan payback arrangements as well for primary care docs in underserved areas. I’ve also read of communities recruiting docs with signing bonuses and other perks (free rent, for example).
Finally, I know an FP doc here in northern Virginia - NOT an underserved area - who was recruited to his current position with a bonus that served as loan payback.
Average indebtedness for medical students is around $100K but it varies hugely. For private allopathic schools and DO schools (which are almost all private) it can be more. Only if someone needs to borrow for tuition AND living expenses is it likely to approach or exceed $200K. I just finished at one of the most expensive med schools in the US, borrowed for all of my tuition but none of my living expenses, and at the moment my loan balance is $143K. Which is daunting but frankly I think it will be quite do-able. I am not worrying about it.


I tried the link and it will not allow me to enter that site for some reason. …

Erica, just try again as the site may have been down. I just tried the embedded link above and it worked.
About the NHSC loan payback program that Mary talked about: It is only for two years, but you can ask/apply for more years. Also, it is very competitive and I think I remember reading that those who are already serving in an underserved area are choosen first. However, not only do you get the $50K, but a 39% tax offset as well.
The difference between the two is that with the scholarship you not only get tuition and all fees paid, but also things like microscope if required, labtop if your school requires them, all books and medical equipment, health and malpractice insurance, your boards (I and II), plus a stipend of over $1,100 per month.

First, welcome to OPM! As you have seen, we’re full of helpful folks!
One option for you & debt load…one I am surprised no one has yet mentioned. Once you have an acceptance, if you are serious about remaining in your community or one similar to it, consider approaching the city council about assisting in funding your education in return for a commitment to return to their community as an FP, IM or Peds doc. Being as I am going to be a specialist, I never investigated it personally. But, I had classmates who had made such arrangements. Furthermore, outside of the NHSC (Nat Health Serv Corp), there are states who will also partially/fully fund your medical education in exchange for a commitment to practice in one of the underserved areas…generally, you get to select the underserved area. I also had classmates on this sort of scholarship.