A native of Deer River, Minnesota—a town of about 1,000 people—Eastan Marleau, MD, understands the unique needs of smaller communities. Because of that, his desire to practice rural medicine was a motivating factor in his decision to become a physician.
As residency applicants prepare to submit their rank-order list ahead of the Feb. 28 deadline, Dr. Marleau—a third-year general surgery resident at Sanford Health in Sioux Falls, South Dakota—offered some insight on life in a rural program.
Sanford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Here are some takeaways for residents weighing the pros and cons of a rural residency.
Opportunity is ample
As a learner, Dr. Marleau has found that the chances to diversify his skillset are numerous.
“For surgery—and it’s probably similar for other specialties—you get unparalleled autonomy,” he said. “There’s no fighting for cases ever. We don’t have fellows to contend with. I have an interest in vascular procedures, and I can scrub in on those any day I want. The high autonomy and limited competition for cases allow you to really prepare yourself for the type of practice you want to have as an attending.”
You might be on the road
Sanford Health has a large footprint. Training at a physician-led health system that includes 46 hospitals and more than 300 clinics, Dr. Marleau does rotations in smaller towns such as Yankton, South Dakota, which has a population of around 15,000. Yankton is about 80 miles away from Sioux Falls, and Dr. Marleau lives in a residency-provided apartment during that rotation.
On those rotations, “you get a better idea of what life as a rural surgeon is like,” said Dr. Marleau.
“The patients I see in the rural rotations aren’t much different from the patients I see in Sioux Falls, but they are older on average.”
Your town might surprise you
There is a perception that going to a rural program means that you are in a one stoplight town. Dr. Marleau, however, has found that not to be the case. He is based in Sioux Falls, which has a population near 200,000.
“People coming here from a medical school that was in a big city are probably going to be surprised,” he said. “I have lived in small towns, large cities and Sioux Falls. Most rural residencies offer all the amenities you need, especially on a busy resident schedule, and there are plenty of places to go out, eat good food, and entertain your family.”
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Cost of living is key
Dr. Marleau has found that a resident’s salary goes a long way in a smaller city.
“We get paid pretty well for the cost of living,” he said. “That is a definite pro of being in a rural residency. We were able to buy a house when we got here, and my wife is a stay-at-home mom now and that’s not an issue from a salary standpoint. Then there’s a lot of things to do in Sioux Falls that are family friendly.”
He also touted the benefits the program provides such as free parking, free meals and well equipped lounges and workstations for residents.
Flexibility is a necessity
Across five training years there are 16 total general surgery residents in Sanford’s program. Because of that, coverage requires a bit more flexibility among trainees.
“Being a team player at a small program is critical,” he said. “That means you are willing to pick up for your co-residents when things happen. My co-residents had to step up for me when my wife and I had our son. They were on three weekends in a row when I was on paternity leave. One of our residents had a parent get sick and we had to shuffle around schedules and vacation time.”
“There’s give and take. If you are flexible and helpful when things come up in other people’s lives, they’ll do the same for you.”
Training experience is paramount
In speaking to future residents who are weighing their future options, Dr. Marleau offered that “you really need to look at a place where you think you are going to get excellent training. That has to be the No. 1 thing to consider. After that, identify a program where you think you’ll enjoy the people and the place.”
The AMA Road to Residency series provides medical students, international medical graduates and others with guidance on preparing for residency application, acing your residency interview, putting together your rank-order list and more.
