Wilhelmi Lisa, Ingendae Freya, Steinhaeuser Jost
Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, House 50, 23538 Lübeck, Schleswig-Holstein, Germany
Rural Remote Health. 2018 Nov;18(4):4694. doi: 10.22605/RRH4694. Epub 2018 Nov 19.
The increasing shortage of physicians, especially general practitioners (GPs), in rural areas is an issue in most western countries. Many redistribution strategies have been utilized in the past to counter this shortage. The physician's perception of rural areas might be an underestimated aspect of a subsequent choice of living and working environment. The aim of this study was to explore determinants influencing this subjective perception of rurality and to develop further strategies to resolve the physician shortage in rural areas.
A qualitative study with semi-structured interviews and focus groups consisting of medical students and postgraduate trainees in Germany was conducted. The interviews and focus groups were recorded, transcribed and evaluated both deductively and inductively by two independent researchers using qualitative content analysis.
Participants had an average age of 28 years. Of 16 medical students and 17 postgraduate trainees, there were 24 women and 9 men. The perception of rurality was strongly influenced by a personal connection (eg family background or personal experiences), which resulted in positive and/or negative associations with rural life and was also a decisive factor for the decision to live in rural areas. Without any kind of personal connection, the choice to work in a rural area was unlikely. Depending on life stage (eg having partners and/or children), different factors were relevant, such as cultural offerings, diversity, accessibility and quality of educational structures (kindergarten/school). Prejudices and a negative image of family medicine deterred students from choosing a career as a GP, whereas postgraduate trainees didn't feel adequately prepared to be fully competent to practice as a GP outside a metropolitan area.
Strategies must be developed to raise awareness and create a personal connection to rural areas during under- and postgraduate medical training. Attention should be given to highlighting family friendliness (child care, schools), the attractiveness of working conditions and to improving deficiencies in local infrastructure (internet and or traffic connections). Additionally, there is a need to strengthen the national standardized and structured postgraduate training as well as collegial exchange and the possibility to work in a group practice or as an employee in rural areas.
在大多数西方国家，农村地区医生尤其是全科医生日益短缺是一个问题。过去已采用多种重新分配策略来应对这一短缺。医生对农村地区的看法可能是影响其后续生活和工作环境选择的一个被低估的因素。本研究的目的是探讨影响这种对农村地区主观认知的决定因素，并制定进一步的策略来解决农村地区的医生短缺问题。
在德国对医学生和研究生进行了一项采用半结构化访谈和焦点小组的定性研究。访谈和焦点小组进行了录音、转录，并由两名独立研究人员使用定性内容分析法进行了演绎和归纳评估。
参与者的平均年龄为28岁。16名医学生和17名研究生中，有24名女性和9名男性。对农村地区的认知受到个人关联（如家庭背景或个人经历）的强烈影响，这导致了与农村生活的积极和/或消极联想，也是决定是否在农村地区生活的一个决定性因素。没有任何个人关联，选择在农村地区工作的可能性不大。根据生活阶段（如有伴侣和/或孩子），不同因素会产生影响，如文化活动、多样性、可达性以及教育机构（幼儿园/学校）的质量。对家庭医学的偏见和负面印象使学生不愿选择全科医生职业，而研究生则觉得没有充分准备好在大都市地区以外完全胜任全科医生的工作。
必须制定策略，在本科和研究生医学培训期间提高对农村地区的认识并建立个人与农村地区的联系。应注意突出家庭友好性（儿童保育、学校）、工作条件的吸引力以及改善当地基础设施的不足（互联网和/或交通连接）。此外，有必要加强全国标准化和结构化的研究生培训以及同行交流，并提供在农村地区集体执业或受雇工作的可能性。
