Working hard but working differently: a qualitative study of the impact of generational change on rural health care

Abstract

Background: There is limited literature evaluating generational change in the physician workforce and the adjustments required of practices, practitioners and the health care system as a whole. The purpose of this study was to explore rural practitioners' experiences of their current contexts relevant to recruitment and retention and to determine how practices are responding to changing aspirations of new practitioners. Methods:We used qualitative methods. Participants were selected to ensure diversity of career stage. Semistructured interviews conducted with 39 physicians, 2 nurses and 1 practice administrator from rural northwestern Canada (British Columbia, the Yukon Territory and the Northwest Territories) between June and October 2016 sought participants' views on research, training, recruitment and retention in the rural setting. Interviews lasted 30-50 minutes with the exception of 4 group interviews (45-90 min). Interviews were then conducted with 4 rural practitioners on Vancouver Island to confirm emerging themes. The interviews were recorded and analyzed interpretively.Results: Three themes were identified that showed the interplay among practitioners, patients and resources within a rural health environment: 1) scope of practice and the changing concept of generalism, 2) connectivity and relationships and 3) divergent career aspirations. Within these themes, generational differences between early-career physicians and established practitioners influenced changes under way in rural practice in terms of adapting the practice environment to enhance recruitment and retention.Interpretation: Some rural practices are beginning to adapt in ways that reflect changing generational aspirations. Specifically, they provide environments that support and nurture young physicians, encourage collaborative working and include flexible working arrangements, with varying support and financial models. Rural practices that were responsive to changing aspirations reported success in recruitment and retention. among physicians who choose rural practice. [3][4][5][6][7][8] We aimed to explore rural practitioners' experiences to understand the adaptations, successes and challenges influencing recruitment and retention in rural health care to answer the question of how practices are responding to the influence of the incoming generation of practitioners. Methods Setting and designThis was a qualitative interview study conducted in rural practices in northwestern Canada. The first author was the regional associate dean for the Northern Medical Program of the University of British Columbia Faculty of Medicine from 2003 to 2011 and then executive associate dean, education from 2011 to 2016 and is known throughout northern British Columbia. Some participants were former students of the Northern Medical Program and some had been met previously through community visits; most had not been met before. The study design took this into account and used an interpretive approach, related to hermeneutics, 16,17 which acknowledges that the ...

Starting out rural: a qualitative study of the experiences of family physician graduates transitioning to practice in rural Ontario

“…Many studies show success for short-term recruitment but not long-term retention. 26,27 Some Canadian studies emphasize the importance of community characteristics (e.g., collegiality, team-based culture and mentorship availability) over financial incentives to retain physicians, 28,29 which were affirmed in this study.…”

Evaluation of surgical oncology fellowship websites: Are we showing what applicants need to see?

“…Millennials have increased priorities toward work–life balance, schedule flexibility, and location. This trend is prevalent among millennial medical professionals as well [ [18] , [19] , [20] ]. Our study demonstrates that many of these variables, such as call schedule, vacation, and city information, along with pertinent fellowship details such as contract, teaching responsibilities, and operative case list, are not being reported on surgical and breast oncology fellowship websites.…”

Plan, recruit, retain: a framework for local healthcare organizations to achieve a stable remote rural workforce

“…There is substantial potential for further research and for practical experience in utilizing the Framework. Further research into implementing the Framework will need to be informed by changing expectations among health professionals who are potential recruits into remote rural health services [ 46 ].…”