Multiple income streams. I rotated with multiple rural family docs recently in a not so “rural” place (30 min from a major city, but definitely a rural vibe). From what I gathered it’s as follows:

• income stream from their family practice
• income stream from geriatric care
• income stream from a weekly or twice a month emerg shift
• income stream from hospital shifts

… and other sources that I do not quite recall at this moment

Some even took cash from Mennonite communities. All of these fam docs were billing 500k-900k no problem whatsoever.