When determining where to live and practice, consider these five pros and cons, myths, and exaggerations of rural and urban practice settings.

  1. There are friendly people.

Yes, people in rural communities are friendly. Sometimes you may even have unsolicited friendliness. I can tell you first-hand that the bonds and relationships you make while living in a rural community are worth the few times you must stop when you are not in the mood to have a conversation.

Advice for the rural physician: Have some boundaries. If there is only one grocery store near you, and you go with your family or you run in to get something, you will consistently be stopped by patients asking health questions. Have a standard answer that’s the same for every person, like, “It is so nice to see you; I am sorry I am with my family, and I can’t stop to visit. Take care.” Or “It is so nice to see you; I am sorry I am just running in, and I can’t stop to visit; I would love to talk to you in the office. Take care.”

This does not mean that communities in metro areas are not friendly as well. These areas often have a more diverse group of people, and some studies suggest because of the diversity that comes with city living, some cities are even warmer than their neighboring rural areas.

Advice for the metropolitan physician: Be sure to make relationships outside of your work environment. This may be related to your family, your spouse, your kids’ sports activities or a hobby you enjoy.

  1. Living and practicing in a rural environment means there is nothing to do.

People who prefer to live in a more rural environment report being friends with their neighbors. Sometimes, in a rural setting, you may have the opportunity to know your neighbor, and because of that, you might have the ability to invite people around you into your home and notice them at a local picnic or fair. People in a rural environment tend to share outdoor experiences more and, therefore, have a sense of community.

Living in a metropolitan area, on the other hand, you get to enjoy trending places like farm-to-table restaurants, you can maintain your social group and you can get to more places easier with more transportation options.

  1. Patients appreciate you more in a rural setting.

This is true in both rural and metro settings, but because there is less access to health care in a rural environment, there is a perception that people in rural communities are more grateful to have you there as a physician.

Patients in metropolitan areas are just as grateful for a good physician. In some cases, metro areas give patients more physician choices but less opportunity for access to excellent health care. There are just as many low-income areas in metropolitan locations as there are in rural locations.

  1. There are no specialists that you can work with or refer to in a rural setting.

In some cases this is true, but not always. Many rural markets have extremely well-trained physicians with traveling specialists who come into the community once or twice a week. Some only come in once or twice a month, depending on the subspecialty.

If you are in a metro area, your subspecialty may be saturated, and you will have no way to stand out in the marketplace. This depends on your specialty and what your organization has decided to do with its marketing efforts. One thing you can do is offer to go to one of the rural markets one or two days a week. Then people from all over will start to get to know you, and you will begin to receive referrals from everywhere.

  1. Living and practicing in a rural community offers you a lower cost of living.

This is true in almost every situation across the country. Living in a rural community provides, in many cases, a larger home for less money. But remember, when it comes time to sell your house, it may be harder to find a buyer than it would in a metro area. There will be fewer choices to buy a home that fits your needs unless you have time to build a house. In addition, there are usually little to no opportunities to rent in a rural setting.

While deciding what to do and where to practice post-residency or -fellowship, and to obtain a broad-based foundation, students should consider getting clinical experience in both metropolitan and rural settings.