Siting Your Rural Rheumatology Practice & Other Rural Rheum Concerns

Everyone knows there is one rule in real estate. Whether you want to build a skyscraper or locate a rheumatology office, that rule is location, location, location. But what if that location is rural? Then what?

Rheumatologists seeking to open their doors in a rural or underserved area need to approach their site selection for a physical office with the specific needs of their clientele in mind, says Wendy Welch, PhD, director of the Graduate Medical Education Consortium of Southwest Virginia, which looks to recruit and retain local doctors in its rural corner of the state.

“Think about the donut hole in rural population,” Dr. Welch says in an email interview with The Rheumatologist. “Where is the aging population likely to stick? … If you chase the younger crowd, you will have a revolving population.”

Art & Anecdotes
Dr. Welch, editor of Public Health in Appalachia, a rural-medicine textbook, says that locating a rural practice is more art than science, because anecdotal evidence for success can be just as predictive as data. For example, some practitioners think that locating in a region’s most centralized city may be the most effective way to reach the most people. However, Dr. Welch suggests that a major driver to office traffic in rural areas is proximity to a supermarket, rather than a highway.

“People in small towns go to the doctor where the grocery store is, and the city is more a place to avoid than a day out, especially when you need care,” she says, adding, “if you’re near a city, you’re near competition. Whereas if you’re near a grocery store, you’re probably the only specialist in your community and an entire county’s population keeps walking past you.”

Although rheumatology is not typically a specialty focused on emergencies, Dr. Welch notes that in snowstorms and bad weather events, roads to grocery stores and the surrounding area are often cleared and repaired first, to provide access.

Support Staff
Another key factor in where to build a rural practice is where to hire from. Always look to hire local professionals for support staff, especially for those positions that are patient-facing, Dr. Welch says.

“Front-line staff are the key to moving from ‘the incomer’ to ‘our doctor,’” she says. “Choose someone as kind as [they are] efficient, whose accent reflects a welcoming voice. … People are more comfortable with what they know—the voice patterns they recognize, the last names they grew up around. [It’s] the instant trust factor a trusted face gets you, immediate buy-in because you’re with her, or him—or more correctly, they are with you.”