Working hard but working differently: a qualitative study of the impact of generational change on rural health care
Bibliographic record
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.003 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".