Choosing where to practice medicine shapes not just your professional life, but your daily routine, earning potential, patient relationships, and career trajectory. In today’s healthcare landscape, physicians have more options than ever—from traditional practices in cities, suburbs, and rural communities to telemedicine opportunities that transcend geography entirely.
Urban Practice: The Metropolitan Medicine Experience
Lifestyle & Compensation
Urban practices place you at the center of cultural attractions, dining, and diverse communities, but with higher costs of living and challenging commutes. Compensation varies widely—academic medical centers may offer lower base salaries but provide research opportunities, teaching roles, and loan repayment programs. Private practices and health systems often pay competitively, though typically not at rural levels.
Patient Mix & Clinical Opportunities
Urban practices expose you to remarkable diversity and complex cases. You’ll encounter rare conditions and patients from around the world with robust specialist networks readily available. The concentration of medical facilities means opportunities for collaboration, clinical trials, and cutting-edge technology, though also competition for patients.
Growth Prospects
Cities offer unparalleled networking and career mobility. You can move between institutions without relocating your family. Leadership positions, speaking engagements, and academic appointments are more accessible, though physician saturation can limit practice ownership opportunities.
Who Thrives Here?
Urban practice suits physicians who value intellectual stimulation, diversity, and amenities. If you’re energized by complexity, want to combine clinical work with research or teaching, or need loan repayment programs, urban settings may be ideal.
Suburban Practice: The Balance Point
Lifestyle & Compensation
Suburban practices often deliver the “best of both worlds”—proximity to urban amenities with larger homes, yards, and highly-rated schools. Compensation is competitive, often matching or exceeding urban salaries with lower costs of living. Many suburban practices are part of large health systems providing stability and structured career paths.
Patient Mix & Clinical Opportunities
Suburban populations tend to be more homogeneous with higher insurance coverage and health literacy. You’ll establish long-term relationships with patients and families across generations, seeing plenty of bread-and-butter cases with good specialist access nearby.
Growth Prospects
Suburban healthcare is experiencing significant growth as populations age and families leave cities. Partnership tracks in private practices remain viable, and leadership opportunities exist within health systems.
Who Thrives Here?
Suburban practice attracts physicians seeking work-life balance and family-friendly environments. If you want a manageable commute, strong schools, and traditional practice patterns while maintaining professional sophistication, suburban settings are worth considering.
Rural Practice: Making a Profound Impact
Lifestyle & Compensation
Rural practice offers tight-knit communities, outdoor recreation, and dramatically lower costs of living. However, access to cultural amenities and specialized services is limited. Compensation is often surprisingly strong—rural practices typically offer higher base salaries, generous signing bonuses, and loan repayment assistance. Combined with lower living costs, this accelerates wealth building and debt repayment.
Patient Mix & Clinical Opportunities
Rural medicine demands broad clinical skills and comfort with uncertainty. You’ll manage everything from routine care to urgent situations, developing deep patient relationships across multiple generations. However, you’ll encounter higher rates of chronic disease, less health literacy, and must manage more independently with limited specialist access.
Growth Prospects
Critical physician shortages mean excellent job security and rapid leadership opportunities. However, career mobility is geographically limited—changing jobs likely means relocating.
Who Thrives Here?
Rural practice suits physicians who value autonomy, broad scope, and community integration. Family medicine physicians, general internists, and those with significant student debt should seriously consider rural opportunities given the compensation and loan repayment programs.
What are the best States for Physicians?
Telemedicine: The Virtual Frontier
Lifestyle & Compensation
Telemedicine offers unprecedented flexibility—work from anywhere with reliable internet. No commute means reclaiming hours weekly. Compensation varies enormously, from hourly rates exceeding traditional practice to lower pay with no benefits, requiring you to manage your own insurance and retirement.
Patient Mix & Clinical Opportunities
Telemedicine expands access but limits scope—you’ll handle acute issues, follow-ups, and medication management without procedures or physical exams. Patient interactions are more transactional and less personal, though you’ll reach people who might otherwise go without care.
Growth Prospects
Telemedicine is expanding rapidly, but reimbursement policies remain in flux and regulatory requirements vary by state. Career paths are still emerging, though combining telemedicine with in-person practice is increasingly common.
Who Thrives Here?
Telemedicine suits physicians seeking flexibility or location independence. Primary care physicians, psychiatrists, and cognitive specialists adapt well. It also appeals to semi-retired physicians, those with disabilities limiting physical practice, or physicians supplementing traditional income.
Essential Questions When Evaluating Opportunities
For Rural Positions
- What’s the call schedule and specialist support?
- How long has this position been open? Why did the last physician leave?
- What mid-level provider support and locum coverage exists?
- What are schools like? What employment opportunities exist for my spouse?
- What’s included in loan repayment? Are there restrictive covenants?
For Urban Positions
- How does this practice distinguish itself in a competitive market?
- What’s the financial health and patient volume trend?
- What CME, research, or leadership opportunities exist?
- What’s the realistic call burden and payer mix?
- What’s the timeline to promotion and expectations for research?
For Suburban Positions
- Is this practice independent or system-owned? What’s the trajectory?
- Is the community growing or aging? What’s happening with local employers?
- What’s the competition from other practices or urgent care centers?
- If partnership is offered, what are the terms and practice value?
- How predictable is the schedule and weekend coverage?
For Telemedicine Positions
- What state licenses are required? Who pays licensing fees?
- What conditions will I treat? What resources are available for escalation?
- What platform is used? What IT support exists?
- How are productivity and quality measured? What’s realistic earning potential?
- What malpractice coverage is provided? How are multi-state claims handled?
- How much schedule control do I have? Can this be combined with in-person practice?
Making Your Decision
The right practice setting depends on your priorities, personality, and life stage. Consider these factors holistically:
Financial: Total compensation, loan repayment, cost of living, partnership potential, and long-term wealth building.
Professional: Scope of practice, intellectual stimulation, autonomy, career development, and long-term prospects.
Personal: Family needs, spousal employment, schools, lifestyle preferences, and proximity to extended family.
Values: Patient relationships, community impact, work-life balance, and the type of medicine you find most fulfilling.
Visit potential communities or shadow in telemedicine settings before committing. Talk to current physicians candidly. Review contracts carefully with an experienced attorney.
The practice setting you choose will profoundly shape your career satisfaction and personal happiness. Whether you’re drawn to urban medicine’s intensity, suburban practice’s balance, rural care’s impact, or telemedicine’s innovation, the right opportunity is out there—you just need to know what questions to ask and what matters most to you.
Written by Paul Strubell / Physemp.com
