A number of attitudinal and perceptual barriers have been identified as
discouraging medical graduates from entering rural practice. Some of these are
misperceptions and others have a basis in reality. The key misperception is
that rural practice is somehow "second class medical practice". Most
undergraduate medical students have a city background and so have no personal
experience of living and working in the country. In addition, most of the
senior teachers in medical schools have an experience and view of medicine
which sees teaching hospital practice as the ideal. Consequently, they assume
that medical practice in rural areas without the same facilities and support as
teaching hospitals is of a lesser standard.
An important attitudinal problem is that of "learned helplessness". The
highest that many new medical graduates aspire to in dealing with medical
problems is being able to assess to which specialist to refer the patient .
Consequently, it is a frightening prospect for them to contemplate rural
practice where they have to manage problems themselves without immediate access
to high technology medical facilities and specialists.
There are a number of other barriers which add to the disincentives for new
graduates contemplating rural practice. These include the heavy workload and
long hours on call which are likely to continue while there is a shortage of
doctors in the country. A lack of infrastructure and regional support is
common to rural practice, especially in developing countries. Also, the
relative professional isolation, which provides many challenges and rewards for
rural doctors is seen as a negative factor for many students and new graduates.
Often this aspect is over-emphasised within the context of urban-based training
rather than the development of individual knowledge and skills required and
organisational strategies to address rural health needs.
As well as the professional disincentives to rural practice, there are personal
and family issues as well. Rural practice, particularly in small communities,
may be difficult for the doctor's spouse. Often the spouse is treated
differently from other members of the community and may become personally
isolated. Employment for the spouse and education for the family are often
significant problems in rural practice. Arrangement of locum relief to permit
holidays and continuing education is often a major difficulty.
Even for those students and recent medical graduates who wish to enter rural
practice, there are difficulties in obtaining appropriate training and ongoing
educational support. Tailored training programs preparing medical graduates
for rural practice are relatively few . Once in rural practice not only is
continuing education difficult to arrange, but often proves to be of limited
value to practising rural doctors. Generally, the knowledge and skills
acquired through experience in rural practice are not given due recognition.
This limits the potential for career development of doctors who choose to
practice in country areas.
Drawing all these factors together it is not surprising that in the view of
many undergraduates and new medical graduates the professional and social
advantages of rural practice are overwhelmed by the disadvantages. In order to
overcome these problems there needs to be developed a series of comprehensive
strategies which address all the specific issues. This policy document has
been developed drawing on the experience in many countries around the world and
forms the framework for a comprehensive strategy plan to improve the
recruitment and retention of rural family physicians.