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July 1, 2010

Specialties, rural medicine, and Medicare, oh my!

Kentucky horse farm landscape

On a recent trip to Chicago, my husband and I made the rounds of our favorite haunts. Being from a town of about 50,000, we enjoy the wealth of choices the Windy City offers. We made our usual trek to Old Town to the saltwater aquarium store to gaze at the tropical fish, wandered up the street to treat ourselves to the best caramel apples we’ve ever tasted, and then entered one of my favorite places: The Spice House. The aroma envelops you the minute you open the door - sweet Chinese cinnamon and Mexican, Moroccan saffron (the world’s most expensive spice), the more subtle smells of Spanish basil and Greek oregano. It’s like traveling around the world. If you love to cook, the plethora of choice is awe-inspiring and a bit overwhelming.

Choosing a location and specialty

Deciding on a type of practice can be just as overwhelming - and certainly much more significant. This step is the first, and therefore the most critical, when it comes to launching your job search. Location is important, too, but if you come home from work every day miserable because of the politics that tend to accompany an academic setting, a picturesque view isn’t likely to soothe your frustrated soul for long. In "The Practice Primer," beginning on page 18, writer Julie Sturgeon gives you a snapshot of the most common types of practices.

The allure of rural medicine

Although the categories of practice types from which to choose will be more limited, the range of care you’ll provide will be extremely varied if choose a rural environment. Our second feature this issue, "Rural Medicine: Worth a Second Look," by Teresa Odle, describes the predicament the people who live in rural communities face in accessing health care. The American Academy of Family Physicians estimates that 25 percent of Americans live in rural areas but only 10 percent of physicians practice there. Fewer doctors are choosing family medicine and even fewer are exposed to what practicing in a rural community can offer. Healthcare reform is attempting to turn the tide but rural physicians urge their citified colleagues to take a trip to the country and learn for themselves that the myths about rural practice are just that.

Medicare or no?

Our third feature article is about a choice physicians make regardless of the type of practice they have chosen, and it’s one that affects a circle of people far bigger than the one that includes themselves and their families. The decision of whether to opt of out of Medicare has ramifications for the physicians, their staffs, their patients, and medicine as a whole. In "Should You Opt Out of Medicare?" writer Vicki Gerson takes a look at this issue and why it has risen to the national stage. Doctors driven to the brink of frustration with what they call "the hassle factor," a confidence that the practice balance sheet will be better off, and a willingness to take a gamble that enough patients will stick with them is leading more physicians to abandon the nation’s oldest safety net for senior citizens. Ethicists raise questions about whether it’s responsible and others say the system is so broken that abandoning a sinking ship isn’t the problem. Take a look and see what you think, beginning on page 36.



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