Table 7 Participant perspectives on influences on location of practice

Training influences on location of practice

 Medical school and residency

“My family medicine rotation in the city compared to what I did here [rurally], like just the collegiality between the physician and the patients was so different, I thought. Anyway, I really enjoyed it. And I knew I was going to do rural family medicine just from that point on.” P28 NS

“I did a lot of my med school family rotations rurally around [names of cities] and smaller towns around that area. And I think they all just reaffirmed for me that it was the right setting for my practice in the future.” P44 ON

Professional influences on location of practice

 Policies and regulations

“So I’ve noticed, you know, if I work as a locum in a place and I don’t feel like I’m being compensated well, I don’t go back to that place. And part of why I’ve been working up north is also because it’s compensated a bit better than [city] was.” P12 BC

“So like overall, working in BC has been very stressful. Like the amount of work for the compensation is a lot higher than what I’m used to practicing in Alberta. And just going back to BC where BC is notorious for having like a culture where you have to pump through patients whether you want to or not, that work is very tiring. And to kind of give myself a break where I can slow down, I go to Alberta.” P21 BC

“To me the licencing process was incredibly cumbersome going from one province to the other, and it’s definitely a barrier. I’ve had job offers in other provinces. But the idea that I’d apply for another licence definitely throws a barrier to why I don’t want to work in any other provinces.” P54 BC

“So when I looked at other compensation models both in Ontario and outside of Ontario, in different provinces and territories, I realized that Ontario is a very good place to work. Specifically rural Ontario is a very good place to work.” P55 ON

 Challenges in rural settings

“I think it’s more in terms of being kind of worried or afraid of not being able to provide the care that is needed [in a rural setting] because you don’t have all the supports that you have in an urban setting. So here if someone kind of breaks something, you just call the orthopedic surgeon or send them to the ER and they’ll deal with that. If you are in a very small community, you probably have the support over the phone. But at the end of the day, you’re still the one who’s doing all those things that I don’t feel comfortable doing.” P4 BC

“However, when we talk about more rural settings, because I was trained in a more urban program, sometimes I feel like the skills to manage acute situations in a rural setting, the program may not have given me.” P16 BC

“And it was kind of a little bit heavy in terms of workload [small town in another province] and trying to balance that with life. So we looked at other opportunities. Which is what brought us to NS.” P39 NS

 Meaningful and valued work

“I like having a versatile skill set in medicine. Like I don’t know that I would be very happy with a very narrow scope of practice. … And a rural family practice allows for that especially because there's a lot more opportunities to kind of get skills outside of the usual.” P39 NS

“I chose to do rural practice because I wanted to have family medicine skills but also other skills that could make me a good doctor overall.” P58 ON

Personal influences on location of practice

 Family and relationships

“Yeah, maybe if I’d married someone different, I might have ended up doing rural work. But yeah, I ended up with a fairly urban partner. I think if it was earlier on in my career, I would have considered doing rural-type work. But I don’t think that’s in my future.” P9 BC

“I think the work that my wife does and where she works plays a large role in me ending up geographically where I am. And I think that also plays a role in where we’re living. So I think that’s really influenced where I practice and my style of practice.” P13 BC

“… moving back home allowed us to be close to both sets of parents as well as siblings and their children. As well as live and work in a city that we know very well but also is much more affordable and allows for a more balanced way of life.” P35 NS

“So partner-wise, you really can’t go anywhere rural because your partner has a job in a city. And that kind of limits where you can move or work as well. Because you can’t go to a rural area if they do something that’s more like big business or like a big kind of executive thing. You can’t go to a small town.” P50 ON

 Community

“The BC College has very strict guidelines around what kinds of personal relationships you can have with patients … and in the sense that, you know, you can’t be friends with your patients, you can really have very minimal sort of personal interaction with patients. Which in a community of a 1000–2000 people where you’re the physician to essentially everybody in the community means that it’s not a place you can really live a life. So I think the only way to work in a place like that is really to come and go, and have a life elsewhere.” P2 BC

“And the longer that we’ve stayed in [name city] … the less we are likely to leave because we’ve made these really great friends both personally and professionally … So I guess having gone to school and done residency there has definitely shaped where we’ve decided to stay. Because now my husband has worked there and made friends … and [we] have this whole community around us.” P6 BC

“I trained here, I know the system, I know all the people, I know how everything works. I know who to go to when I have a question … why would I want to go jump straight into an unknown situation when I already know how everything works? So it just was like I already know how this all works so why not just start working?” P43 NS

“I kind of had a plan after third year of medical school … And I knew where I was going to be, at least close to where I grew up. And there was good opportunity about 45, 50 min from the town I grew up in. So I kind of just went there automatically.” P44 ON

“But it’s a really wonderful feeling to be going through the community, whether you’re walking on the street, in a restaurant, a grocery store, and people come up to you and say hi, and they ask you how you’re doing. And they don’t ask because they have to. It’s because they care. Because it’s that sort of community.” P55 ON

 Personality and personal interests

“My lifestyle is vastly based in the outside. And I couldn't get outside as much as I want in a city. And I just figured out what things truly make me happy and the things that I truly enjoy, and then worked to be in a setting that allows me to do them.” P44 ON

“I loved the lifestyle. I loved how beautiful this place was. And it was those factors that made me decide to apply for my full licence here.” P54 BC