Kawabata Hidenobu, Murakami Manabu, Kisa Kengo, Maezawa Masaji
Department of Healthcare Systems Research, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
Hokkaido Igaku Zasshi. 2010 May;85(3):161-5.
The lack of primary care physicians working in rural areas is a major problem both in Japan and worldwide. Particularly in Japan, healthcare provision in the community is seriously deteriorating, due to the absence of a regulated instructional system for primary care physicians in rural areas. Understanding what influences the career choice of rural primary care physicians is vital, and this study aims to examine those factors.
Qualitative research methodology with semi-structured interviews and content analysis was used. All interviews were conducted in interviewees' rural clinics over three days in September 2007 and 2008; each interview lasted for 60 minutes. All interviews were recorded, transcribed verbatim, and analyzed thematically by two independent researchers, then the preliminary results were presented to the third and fourth authors. All authors were in agreement with the final results.
Fourteen physicians (13 males and 1 female; mean age 43-years-old) agreed to participate in the interviews, and four themes emerged: "existence of role models for younger primary care physicians," "affinity with rural backgrounds and culture," "understanding the importance of a holistic approach," and "internal motivation for challenging and rewarding work as a doctor." DISCUSSION & CONCLUSIONS: Our research results were similar to those of previous overseas studies, regardless of differences in cultural background. We could explain our themes with the concept of the "rural pipeline into medical practice" by JP Geyman et al. according to the time frame described therein. Taking some potential limitations like generalizability and translation into account, we could utilize our research results to indicate how the number of rural primary care physicians may be increased.
农村地区缺乏执业的初级保健医生，这在日本乃至全球都是一个重大问题。特别是在日本，由于农村地区缺乏针对初级保健医生的规范教学体系，社区医疗服务正在严重恶化。了解影响农村初级保健医生职业选择的因素至关重要，本研究旨在探讨这些因素。
采用半结构化访谈和内容分析的定性研究方法。所有访谈于2007年9月和2008年的三天内在受访者的农村诊所进行；每次访谈持续60分钟。所有访谈均进行录音，逐字转录，并由两名独立研究人员进行主题分析，然后将初步结果提交给第三和第四作者。所有作者对最终结果达成一致。
14名医生（13名男性和1名女性；平均年龄43岁）同意参与访谈，出现了四个主题：“年轻初级保健医生榜样的存在”、“与农村背景和文化的亲和力”、“理解整体医疗方法的重要性”以及“作为医生从事具有挑战性和回报性工作的内在动力”。讨论与结论：无论文化背景存在差异，我们的研究结果与先前的海外研究结果相似。我们可以根据JP·盖曼等人在其中描述的时间框架，用“农村医疗实践渠道”的概念来解释我们的主题。考虑到一些潜在的局限性，如普遍性和翻译问题，我们可以利用我们的研究结果来指出如何增加农村初级保健医生的数量。
