A recent study has established the key differences between rural and urban European practitioners: the preliminary results are available at the EURIPA web site (http://www.euripa.org, at ‘4th Hot topic’). More than 400 family doctors from 33 European countries have responded to an inquest, which aimed to outline the differences between rural and urban practice. Significant results have been found in several areas: recruitment and retention, distance to hospital and ambulance care, work burden and time for patient consultation, solo versus team practice, offices and equipment, computerized consultation possibilities, teaching and learning activities, imbursements and expenditure, living facilities, locum, etc.
NEEDS
Some of the identified needs for rural practitioners have been related to the following areas: educational (less academic activity or publishing; the need for specific rural CME: emergency care has specially been highlighted by the 83% of the responders), resources (fewer human resources and instruments/equipment, greater expenditure, and difficulty in finding locums: a need identified by 75% of the responders), greater implication of their public NHS in helping with imbursements and resources, isolation (distance to secondary and hospital care, to pharmacies and to their own patients: whereas half of the urban community has access to ambulance care in less than 15 min, only a sixth of the rural community has such access), policy making (75% refer to no specific rural health policies and only half have rural representatives in their networks: colleges, scientific associations, etc.), rural practitioners also work in smaller teams and more single handed (50% of the rural versus 30% of the urban), have fewer promotion possibilities, and a higher work load (out of hours, home care for an ageing population).
RECRUITMENT AND RETENTION
Furthermore, some interesting issues for recruitment and retention have been reported. In our European sample, nearly the 70% plan to stay living and practicing at the rural area and only 10% would change their practice to a city if they had an opportunity (a different profile than in most world's regions), even though more than 90% of the rural practitioners miss some kind of living/housing or entertainment facility. A rural European retention paradox seems to have been identified for gender: even though it is true that women are more difficult to recruit to a rural area, those women who keep working in rural areas are keener to continue performing rural practice than men (as a result, gender parity is achieved in the long-term).
PROS AND CONS
Rural practice seems to have its own ‘pros’ and ‘cons.’ For addressing the latter we would suggest: strengthening practice team collaboration: assumption of specific skills by the auxiliary team; specific rural educational issues: rural practice as a core competency; avoiding procedural limits or handicaps: ‘see what they need, show them how, but please let them do;’ involving the communities: social accountability; increasing efficiency of the work load; stimulating recruitment and retention: the establishment of an effective rural pipeline.
Rural practitioners are expected to do ‘more’ with ‘less’: a specific differential profile. The challenge is to cope with it.