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Rural and urban medical practices are more similar than different, with several notable exceptions
Washington State's rural and urban physicians tend to diagnose and treat similar problems. However, there are a couple of specialties with notable differences. Rural general surgeons are much more apt than their urban counterparts to care for patients with gastroenterologic diseases and to perform endoscopic procedures, such as gastroscopy, sigmoidoscopy, and colonoscopy. Rural obstetrician-gynecologists (OB-GYNs) have more visits out of their specialty domain—for example, hypertension and diabetes—than urban OB-GYNs. Rural general surgeons and OB-GYNs provide care for patients who in urban areas would be seeing other types of physicians. Thus, these rural physicians need training outside their traditional specialty areas so that they can provide their patients with optimal care, suggests a study supported in part by the Agency for Health Care Policy and Research (contract 290-93-0136).
Laura-Mae Baldwin, M.D., M.P.H., and her colleagues at the University of Washington's Rural Health Research Center used 1994 Medicare claims data to compare the number of patients, age and sex of patients, number of outpatient and inpatient visits, diagnosis clusters, and procedure frequency and type for board-certified rural and urban physicians in 12 medical specialties. Overall, 14.4 percent of physicians in the 12 specialties practiced exclusively in rural Washington, with great variation by specialty. Rural physicians saw larger numbers of elderly patients and had higher volumes of outpatient visits than urban physicians. Rural primary care physicians and general surgeons had higher rates of outpatient procedures than their urban counterparts.
Rural/urban differences in the characteristics of physicians and patients, the physicians' practice volumes, and the scope of diagnoses and procedures for some specialties raise questions about the quality and equity of care available to rural patients.
More details are in "Rural and urban physicians: Does the content of the Medicare practices differ?" by Dr. Baldwin, Roger A. Rosenblatt, M.D., M.P.H., Ronald Schneeweiss, M.D., and others, in the Spring 1999 Journal of Rural Health 15(2), pp. 240-251.
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