What leads to the subjective perception of a ‘rural area’? A qualitative study with undergraduate students and postgraduate trainees in Germany to tailor strategies against physician’s shortage

Introduction: The increasing shortage of physicians, especially General Practitioners (GPs) in rural areas is an issue in most western countries. Many redistribution strategies have been utilizedin the past to counter this shortage. The physician’s perception of rural areas might be an underestimated aspect concerning the later 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.

Methods: A qualitative study with semi-structured interviews and focus groups (FG) consisting of medical students and post graduate trainees in Germany were conducted. The interviews and FG were recorded, transcribed and evaluated both deductively and inductively by two independent researchers using qualitative content-analysis.

Results: Participants were on average 28 years old (16 medical students and 17 post graduate trainees), 24 were women, nine men. The perception of rurality was strongly influenced by a personal connection (e.g. 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 idea of working there was unlikely. Depending on the ones phase of life (e.g. before/during family planning), different factors were relevant, such as cultural offers, diversity, accessibility and quality of educational structures (kindergarten/school). Prejudices and a negative image of family medicine deter 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.

Conclusions: Strategies must be developed to raise awareness and create a personal connection to rural areas during under- and postgraduate medical training. Attention should be placed on highlighting the familyfriendliness (child care, schools), the attractiveness of working conditions and on the improvement of deficiencies in local infrastructure (internet/traffic connection). Additionally, there is a need to strengthen the national standardized and structured post graduate training as well as collegial exchange and the possibility to work in a group practice or as an employee in rural areas.