For those J-1 physicians accustomed to working 80 to 100 hour weeks in a large metropolitan area and in an environment akin to that on the television show, ER, relocation to a rural area may come as a cultural shock.  We recommend that you watch the movie, Doc Hollywood, before embarking on your job search.  You will get a rough idea about where many of you will work and live for at least three to five years. 

Based on interviews with physician recruiters, employers, hospital administrators, and physicians themselves, we provide the following real world tips, which if followed, will help you create a rich, rewarding, and successful experience.  These tips are in no way intended to offend anyone’s culture, nationality, or religion.  Rather they are meant to introduce life in rural America as it is.  

1)     Resume and Cover Letter.    

This is the all important paper introduction of yourself to your prospective employer.  The issue is how to distinguish your resume and cover letter from the many other resumes which employers receive. 

·                  Resumes for rural clinical jobs should be one page only.

·                  For rural jobs, do not list academic achievements or publications. 

·                   Leave out the languages you speak unless the language is Spanish.  The community will be more than happy if you speak English they can understand. 

·                  The resume and cover letter should be on a different color paper so it stands out in a pile.  Just keep it professional.

·                  Do not send references with your resume.  Simply state: References available upon request. 

·                 State your marital status and number of children.  If your spouse has university degrees and an occupation, state this.  A doctor’s spouse in a small community is expected to be a role model and a leader, commiserate with the respect due community has for the physician’s expertise.  List prior volunteer work of spouse.           

2)     Research the community where the job is located. 

Find out about its schools, its history, its festivals, and churches.  If possible, visit the community before sending your resume so you can state you have visited.  In your cover letter, mention the things you like about the community and why you feel it would be a great place to raise children away from the crime and grit of big city living. 

Depending on the community, playing golf and tennis are a big plus and if you don’t know how, take a crash course.  I am told that in some towns, hunting and fishing are essential.  So learn those skills too.    

 State your marital status and number of children.  If your spouse has university degrees and an occupation, state this.  A doctor’s spouse in a small community is expected to be a role model and a leader, commiserate with the respect due community has for the physician’s expertise.  List prior volunteer work of spouse.               

3)     The Interview 

Now that the perfect resume has secured an interview for you, the next step is the all important interview.  Plan to spend several days in the town, including both weekdays and weekends.  Again review the town history and find out who runs the town, the school principals, the ministers, the hospital administrator, the names of the bankers, and the real estate agent.  Ask to meet all of them. 

Take your family to the interview and if your children are school age, ask if you can put them in school for a day to see how they like it.  Make sure your spouse makes a good impression.  They are hiring you and your spouse.  You and your spouse should both have business cards available to give to people you meet in town.

 Ask to see the hospital, nursing homes, and other health care facilities.  If you are a pediatrician, ask to see the nursery. 

 Ask to meet the real estate agent and be shown housing.  Don’t tell them you want to live in an apartment over a drug store.  Doctors in rural America live in houses, not apartments, given their status.

 Wear conservative clothing to the interview.  Women should wear a navy blue suit (not a pant suit), white blouse, navy blue shoes and pearls.  Men should wear a blue or black suit with a tie.

 Make friends with the secretary of your prospective employer.  He or She can be your most valuable ally or worst enemy.  Treat the secretary well.

 As soon as you arrive home, send flowers and a lovely thank you note to the secretary.  Of course, also send a note to the prospective employer.  Employers report this item is one of the biggest sins of omission among physicians. 

Follow up with calls and letters after your interview but don’t wear out your welcome.

NEVER, NEVER HAVE YOUR SPOUSE CALL A PROSPECTIVE EMPLOYER FOR YOU!  WE ARE TOLD THE RESUME OF AN APPLICANT WHOSE SPOUSE CALLS HITS THE WASTE BASKET. 

4)     You are hired, what next?

Meet and greet everyone you see.  Shop in the local stores and introduce yourself.

·                   Do not act like a clock-punching salaried file clerk.  You are a doctor and are considered a God in your town.  You are a huge fish in a small sea.  So, act like a partner in the business because you have a huge stake in the success of the business.  If the business doesn’t make money- you go first, not your boss.

·                   If you are starting a new office for the employer, you are basically on your own in terms of making it a success.  Employers who are also physicians seem terminally unable to understand the economics of rural medical practices in many cases, often expecting the physicians to open a new office in a new community and make a profit for the employers from the first day. 

·                  Often a job will be offered when the employer hasn’t done the math.  Questions such as the source of patients and the source of revenue are not often explored.  It is up to you to do the math.  Your job and security is at state.  If the employer is a public practice, ask if the hospital will guarantee your salary for a year or two.  This is often an indicator of the community need for your services. 

·                  Join civic clubs, such as Rotary, Lions, Kiwanis, or other local civic organizations.  If your spouse is a woman, she should join the Junior League and hospital auxiliary. 

·                  As one of the few doctors in town, and sometimes the only doctor, you are a star, so take up the mantle and run with it.  Don’t cower- Integrate!

·                 You and your family must attend a different church every week as the church is the lifeblood of small towns.  It is important to make the rounds of every church as the parishioners at the churches you miss will be upset and not become patients.  Your religion is not the issue here.  Churches are the core of small town America and you attend to meet people.  Most churches have coffee and cookies after church so be sure to attend. 

·                  Provide free community screenings for common ailments.

·                 Have lunch with all the school principals.  They are a great source of referrals. 

·                  Attend all community festivals with your family.

·                  Play golf and tennis if that is what they do in the community.

·                  Send one or more of your nurses to a professional conference.  Even if you pay out of your own pocket, loyalty and patient referrals result.  You will have a friend for life.

·                 Give seminars at your hospital and at schools.

·                 Try to get a periodic or weekly radio spot to provide general medical advice.  Several physicians have reported that their call-in “Ask the Doc” radio shows have been a great success in bringing in patients. 

·                  Make some house calls.  Everyone in town will know and your good will stock will skyrocket. 

·                  Have your spouse pick up patients who have no transportation. 

5)     Immediately network with the other physicians in the community. 

This is mandatory.  Prior to or immediately upon your arrival in town, you should make an appointment to introduce yourself to all the doctors in the community and pay your respects.  If there are physicians who see you as a competitor, you need to know that.  Show them how you can mutually benefit each other.  It is important to learn the background of the other doctors.  Don’t wander blindly into a medical community.  The practice of medicine is highly political particularly in rural areas. 

6)     Avoid the smart, young, doctor syndrome. 

As a very competent, knowledgeable  physician who just graduated, you may be shocked at the quality of medicine practiced in some rural areas.  Physicians have reported this problem over and over.  If you walk in and flatly tell the old timer that he is medically wrong, you will likely make an enemy.  This doctor is probably loved and revered in the community and the community will be loyal to him/her and to them, having faith in his/her medical skills, not you. 

7)     Spouse must be involved in the community.  

Whatever the occupation of your spouse, he or she can volunteer at the school and at the hospital.  He or she can join civic organizations and charitable organization.  He or she cannot afford to be shy.  He or She must be a role model and leader. 

8)     Make friends with the local journalists. 

Make sure your employer puts an article in the local newspaper announcing your arrival. NOT AN AD, BUT A STORY ABOUT YOU AND YOUR FAMILY.  If necessary, you can write your own story.  It is a very common practice for local papers to write a story about your arrival.  Give them something interesting to write about you and your family.  Praise the city, your employer, and the hospital for their hard work in getting you there.

9)     Attend charity events with your wife and children.  Serve on the boards of charitable organization like the Kidney Foundation, The American Heart Association, or the other healthcare related groups.

10) Arrange a weekly or bi-weekly meeting with your boss. 

It is important to have a review of the medical practice over breakfast on a frequent basis.  Ask about your performance and ask for suggestions on how to obtain more patients and revenue.  If there are revenue problems, it is good to know about it in the early stages so you can work together to solve the problems if possible.