The most frequent conversation recruiters have with physicians is regarding location; discussing the differences between practicing in rural areas (cities with 50K people or less) and urban areas (cities with over 500K people). As someone who grew up in a very rural part of Washington State (Rochester has 5K people and 1 stop light) but has spent the last 14 years living in urban areas (Denver and Los Angeles), I can give a unique perspective from both sides. I represent clients all throughout the country, from Los Angeles and San Francisco to small towns in Oklahoma and Wisconsin with less than 10K people.

Personal Lifestyle

The biggest difference between rural and urban living is the lifestyle. Some of you may be too young to remember the great late 80’s sitcom, Cheers, but the theme was “Where everyone knows, your name”. In rural communities, everyone is on a first name basis, everyone says “hi” to each other, and the entire community grows up and experiences life together. Some of my fondest childhood memories are from potlucks in the backyard where multiple families come over with each bringing their specialty dish based on a generations old family recipes and dozens of kids are running around.

Urban areas are all about options, diversity and convenience. In most major cities, anything you would like is within a 15-mile radius, allowing you to have a wide variety of interests and experiences that you cannot get in smaller communities. It is very common to wake up and jog to the gym, have brunch at a local French bistro, Uber to meet up with friends at a farmer’s market then meet up with the family to go to a professional baseball game. The options are unlimited, and experiences are there for the taking.

Professional Aspect

In smaller, rural areas, the scope of practice is often much wider. There are usually fewer subspecialists around, so physicians must do a little bit of everything. “Jack of all trades” is the mentality you need to have as you will be seeing a little bit of everything. For many physicians, this variety is highly rewarding.

Unlike a rural practice setting where there is limited or no competition, many urban markets are extremely competitive, and making, building and maintaining a full practice more challenging. Therefore, many physicians choose to become very specialized and focus on their one true passion in medicine. It allows them to be on the cutting edge of technology, assist with advancements in medicine, and be an expert in one or two specific fields, as opposed to being more of a generalist.

 Compensation Reality

The location of a practice has a major impact on physician compensation, but the reality is counter intuitive for most physicians.  Most large cities and desirable locations have a surplus of physicians in most specialties. This overabundance of talent (supply) reduces the amount organizations (demand) must pay for top talent. According to a 2016, Beckers Hospital Review, the average Family Medicine physician in a rural area has a base salary 16% higher, and sign on bonus 31% higher than those in urban areas.

• Rural average salary was $227K, sign-on bonus $24K
• Urban average salary was $190K, sign-on bonus $16K

When you couple that with typically higher cost of living in larger cities, the disparity in how much is left in your pocket at the end of the year can be very significant.

At Pacific Companies, we have found there are four main motivating factors when it comes to deciding on a career move. The professional aspect, the personal aspect, the financial aspect and the geographic location.

It’s easy to find an opportunity that matches with two of these factors, and many will match with three, but very rarely will you find one that matches all four. So, you are going to have to sacrifice one of them, the decision you must make is, which one are you willing to give up.

• Casey Galpin | Senior Physician Recruiter | Pacific Companies Inc.