The Challenges of Rural ENT Practice

But how often does a rural ENT need to tap the expertise, experience or resources of a big city colleague? That depends on their comfort and skill levels, Dr. Duck said. “There’s a lot of stuff that I feel like I can do as well as they can do,” he said. “But there’s a lot of stuff I can’t do as well as they can do—like, for instance, head-and-neck cancer. I don’t have time in a rural, one-man practice to do head-and-neck surgery for big head-and-neck cancers. And I have no business doing that, because I can’t make rounds two or three times a day, every day, on these people.” These patients are often more effectively treated in a university setting, he said. “You need residents, and you need a place where it’s done all the time because it’s in the best interest of the patients.” The transfer of patients in those situations depends on the self-confidence and comfort level of the provider, he added.

Another challenge for rural otolaryngologists is dealing with the current onslaught of medical reforms, many of which involve costly and complicated digital components.

Rural physicians are not as likely to adapt as quickly as their urban counterparts, said Dr. Slabach. However, he urges rural ENTs to embrace the technology and take advantage of their typically small practice size.

“Yes, it’s problematic, but because of their size … these changes can occur probably more quickly, assuming that they want to make that transition,” Dr. Slabach added. “Decisions could be made more quickly, and the process could move more efficiently.”

Rural physicians face a variety of challenges that their more urbanized counterparts rarely see. But with proper planning and recognition of the obstacles, most physicians easily overcome them.

—Brock Slabach, MPH

Time, Time and Less Time

Perhaps the ultimate challenge for small-town otolaryngologists is finding time to stop practicing long enough to learn how to do it better. Whether it’s time off for continuing medical education, a conference or just the breaks necessary to prevent burnout, how does an otolaryngologist stop working when he or she is the only game in town?

Realize you can’t do it all and build in time off, Dr. Duck advised. “You have to learn to realize that you can’t save the world, and that you’re needed, but you have to balance it. That’s all,” he said. “You can’t take calls 24/7, you can’t be available all the time and sometimes you have to say no.”