Rural vs Urban

[Duality]

A PA I know told me to try to do my rotations at the many rural hospitals in my area. They told me that the docs there tend to let you get more hands on and can do more because you have to compete with residents etc. at these larger urban facilities. I want to know what your input on this matter.

[Nonlegit]

Heard this before, and although I have never worked at a truly rural facility, I imagine its pretty true. I work in a big ole hospital and occasionally the med students will get in on something good, but for the most part there is not a lot to go around. We have every specialty (residents), students of absolutely every sort, ancillary staff (pharmacy, EMTs like me), etc etc etc. I do less as a tech here compared to community facilities simply because the residents need practice doing splints and lines and stuff. The guys that moonlight other places always tell me to come do nights with them out in the boonies whenever im doing a rotation, they'll hook me up.

 

So I'm a believer, although I haven't experienced it myself.

[medic25]

Look for the best of both worlds; urban county/city hospital without any residents or students. This way you get the volume of pathology without fighting for cases.

[LESH]

Depending upon the facility, it has been my experience that its true.

[lanime]

So true! I love my days at the smaller community/rural hospitals... They are excited I'm there, they are nice and there is a ton of learning & teaching experiences to go around! (I'm currently a transplant coordinator & RN applying to PA school... Just so you have some context with my advice).

[rev ronin]

If you want to see a lot, rotate at an academic tertiary care center.

 

If you want to do a lot, rotate at a rural access hospital.

 

It's soundbite wisdom, but that was my experience: residents are cool and will teach you how to help them, but they need the procedures themselves.

[skyfall]

I worked in rural areas in over half of my rotations and enjoyed them the most. I agree that the people are friendlier, more laidback about you doing stuff, and loved teaching students. Since the facilities are smaller, you not only do a lot, but you also get know many docs and staff who will provide you even more learning opportunities. For example, during surgery, I not only worked my 2 preceptors both general surgeons, but I got to work with ENT, pain management/anesthesiologist, surg PA, gastroenterologist, and OB. For referrals, it was nice to let patients know a little about the doctor if they felt insecure about them. I also found that patients were often more humble and appreciated seeing PA students, which was really cool. 

 

There were a few classmates who did not enjoy having to compete with med students/residents at some of the bigger hospitals, esp since residents were given priority. But I also heard of others enjoyed their rotations in the city. It really depends on the preceptor you get and how the facility treats you!

[tunafish]

Rural was a much better experience for me. It maybe not that much "state of the art" medicine, but you would be way more involved in a patient care. In a big academic center the care is very fragmented and every little thing is done by "every little thing team" so students often shadow and observe rather than do and participate. just my 0.02

[Nonlegit]

Rural was a much better experience for me. It maybe not that much "state of the art" medicine, but you would be way more involved in a patient care. In a big academic center the care is very fragmented and every little thing is done by "every little thing team" so students often shadow and observe rather than do and participate. just my 0.02

 

You reminded me of something that happens often in my department, but I never really noticed before: EM US and EM (and likely the other specialties' physicians that rotate through the ED) routinely have to compete over procedures that can be done w-w/o US. I saw like 12+ docs in a room the other day with a septic knee that needed tapped (and funnily enough, I didn't realize that US could be used in that situation? always learning myself).

 

Big teaching hospitals can definitely impose a barrier to getting your feet wet, especially if you are not familiar with navigating the environment.