> Maintaining a fleet of doctors and facilities that are increasingly rarely used is expensive.
I'm a physician working in NYC. I could make a full 75% more salary if I went to work in a rural area. Very inverse from most professions (I think) where people working in the city make the most. But I think it's that challenging to get physicians to work in rural areas.
This. Staffing these hospitals requires paying very large cash compensation premiums compared to cities. I have a couple acquaintances that worked at these hospitals, and they all did it for the money. Even then, most of them wouldn't do it for any length of time because the sacrifice to their personal and social life is too high.
I was a physician working in NYC. I now make a full 100% more working in the rural Midwest. You can think of it like Uber's surge pricing - pull drivers in when there's a demand-supply mismatch. Except in rural America the mismatch is constant and so is the surge pricing.
A good number of the docs I work with here are actually from around these parts. They setup shop with their families, buy and build large homes on large swathes of land, and buy a propeller plane or two. Others are foreign medical graduates. These areas are almost always designated as medically underserved and that has all sorts of Visa and ultimately green card/citizenship implications. Effectively Trump's "shithole" immigrants are caring for his base.
We're unlikely to ever reach 100% urbanisation. In fact, the trend is likely to reverse to some extent at some point. Long term solutions lie in remote, largely automated care, remote triaging, widely distributed micro and mobile clinics, and efficient transportation infrastructure for when the care can't come to you.
It's big fish in a small pond syndrome. If you have multiple years of college and your interests are fairly intellectual, you are going to be hard pressed to find like-minded friends, etc, in a rural area treating farm hands and the like. It's also tough being, for example, the only doctor in an area because then everyone is your patient and you have an inherent conflict of interest when trying to make friends.
For instance, what about your husband/wife? They just put their career on hold to go live in the boonies for 5 or 10 years? That sort of thing will put an enormous strain on your relationship.
The pay is better, but not sufficiently better to offset benefits of urban life. Offer $5M per year, and it won't be challenging to get physicians to work in rural areas. So the problem is merely that there isn't enough funding to incentivize doctors to work in rural areas.
I'm a physician working in NYC. I could make a full 75% more salary if I went to work in a rural area. Very inverse from most professions (I think) where people working in the city make the most. But I think it's that challenging to get physicians to work in rural areas.