A new frontier

Why I chose a rural hospital for my clinical rotations—and why you should too

Giselle D’Andrea, OMS III, chose to complete her rotations at a rural hospital. Here, she shares her insights and why she encourages other med students to explore rural health care opportunities.


Looking at the list of 20 possible locations for my third-year clinical rotations, I was at a crossroads. Where would I get the most educationally enriching experience? Did I want to begin my clinical training at an academic medical center in a city, at a large suburban hospital network or in a rural community hospital? Now, as I have completed my third-year rotations at a 186-bed hospital in rural western New York, I know that I chose the right path.

According to the U.S. Department of Agriculture, 46 million people lived in rural areas in 2020. This is equivalent to 14% of the population, yet only 10% of physicians practice in a rural area. In metropolitan areas, there are 33 physicians per 10,000 persons compared to 13 physicians per 10,000 persons in rural areas. Rural hospitals are closing at an alarming rate, with nearly 170 closing between 2005 and 2021, further deepening the health care crisis. While these statistics are sobering, they provide an opportunity for a rewarding experience for medical students.

Establishing meaningful connections

There are many advantages for medical students in choosing a rural hospital for their third-year rotations. To begin, rural sites often provide an inherently more personalized experience. I worked directly with an attending physician for all of my rotations, as my site had only a small number of resident physicians. I developed a relationship with the attending physicians I worked with.

I was able to demonstrate my willingness to learn from them, collaborate on patient care and receive direct feedback daily. In fact, several of the physicians I worked with offered to write me recommendation letters before I could even ask for them. They simply wanted to after we worked together. Strong recommendation letters are essential to a student’s residency application. What better way to get a strong letter than to work directly with an attending physician every day?

Real-world opportunities

In a rural hospital, there are often opportunities to have a more hands-on experience than at a larger institution. I was first or second assist for many of the surgeries during my surgical rotations. I was scrubbed in and involved in the cases, not relegated to standing in the corner behind the fellows or residents.

During my internal medicine rotation, a septic patient was transferred from the inpatient wards to the ICU. I helped transport the patient and was then standing right next to the interventional radiologist as he performed an emergency cholecystostomy. These are just a few examples of the many ways in which I was directly involved in patient care.

Previous experience with complex patients and situations are huge assets in preparation for residency. On average, rural residents are older, have a lower median income and are less likely to be insured than their counterparts. Combined with decreased access to care, patients often have many comorbid medical conditions. As a medical student, caring for complex patients presents a unique challenge and opportunity to learn. For patients who are not able to travel to specialists, students can help find creative solutions to ensure patients’ health care needs are met.

Recognizing the downsides

There are, however, some disadvantages to doing third-year rotations at a rural hospital.

Rural hospitals typically do not have trauma capabilities and critically ill patients are often transported to tertiary centers. The newest medical advances and equipment may not be available at rural hospitals. There is also generally less focus on academic research at these hospitals.

Students should keep these factors in mind when considering a rural hospital versus a larger institution with more resources.

As there are generally fewer medical students at rural hospitals, living in a rural area can be a lonely experience at times. Remaining connected to family and to friends at other rotation sites is key. With the advance of technology, students’ support systems are just a video or phone call away.

Having fewer students at the hospital can also be an advantage. I was able to reach my full potential as a medical student without the additional pressure of being compared to my peers. I was able to develop and achieve self-directed goals, an important skill for residency.

Final thoughts

Reflecting on my year at a rural hospital, I am immensely grateful for the opportunity to learn from and serve this community. I made strong connections with the attending physicians, hospital staff and patients. I was actively involved in the care of complex patients and had opportunities that I would not have had elsewhere.

Third-year rotations are a time for students to apply their classroom knowledge to real-world patient care. Attentive and engaged medical students can be an asset to patients, health care professionals and the community. Most importantly, completing third-year rotations at a rural hospital can help shape medical students into well-rounded and independent future physicians.

Related reading:

Insights from a rural OB-GYN: A Q&A with Tammie Koehler, DO

Bill addresses rural health care access and physicians’ medical school debt

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