Exploring rural Scottish GPs' migration decisions: a secondary qualitative analysis considering burnout.

Background: The challenges of recruiting and retaining rural GPs are well described. UK data suggests high levels of burnout, characterised by detachment, exhaustion and cynicism, plays a role in GP turnover. The contrast is engagement with work. There is limited evidence examining the relationship between work engagement and recruitment and retention in rural areas.

Aim: To qualitatively investigate GPs decisions to move or stay in rural areas through exploring areas that can promote work engagement.

Design And Setting: A secondary analysis of qualitative data of Scottish GPs.

Method: A secondary analysis of 44 semi-structured interviews with GPs from across Scotland. Data was analysed thematically and the Areas of Worklife Scale (AWS) was used to structure data.

Results: Factors associated with burnout were identified and experienced as barriers to moving or staying rurally. Fear of dealing with pre-hospital emergency cases, clinical isolation and rural training were concerns. Personal factors such as lack of partner employment played a key role in migration decisions. Factors associated with engagement were identified and experienced as facilitators for moving or staying rurally. Professional networks reduced professional isolation and rural GPs valued increased autonomy and time. Many felt rural GP was more aligned with their professional values and highly valued the rural lifestyle for themselves and their families.

Conclusion: Our data suggests that factors associated with engagement and burnout can contribute to rural GPs' migration decisions. We highlight four areas that could promote desirable work environments through mitigation of burnout and promoting engagement at work.