Category | Positive factors | Negative factors | Not clear/Not reported |
---|---|---|---|
Financial factors | ➢ Improved earning potential (18) ➢ Individual incentive programs (18) ➢ Financial incentives (20, 23, 18, 25, 27, 29, 41, 43, 45) ➢ Adequate and fair pay scale (20) ➢ Transparency of the payment system (16) ➢ High salaries (9, 24) ➢ High Earnings from the practice (9) ➢ Bolstering incomes for employed physicians (14) ➢ Favorable salary levels (14) ➢ Increasing reimbursement levels (14) Remuneration (12,18, 23, 27) ➢ Desirable average monthly payments (7) ➢ Various allowances (7) ➢ Financial bonus (7) ➢ Good revenues/patient volume (13) ➢ Financial support (8) ➢ Increase in physicians’ income (25, 30) ➢ Guarantee of a position (12) ➢ Opportunities to perform research (12) ➢ Financial compensations (26) ➢ Loan repayment (29) ➢ Scholarship throughout their medical education (29) ➢ Wages (36) ➢ Future tuition (36) ➢ An alternate payment plan (39) ➢ Comprehensive payment plans (39) ➢ Increased funding (39) ➢ Direct financial support for overhead expenses (39) ➢ Special funding for rural clinics, including facilities, support staff, and administration, regardless of compensation model (39) ➢ Financial support for travel and accommodation (39) ➢ Financial motivations (40) ➢ Funding for continuing medical education (45) | ➢ Having a partner who wants to live and work in a metropolitan environment (18) ➢ Desire for a metropolitan lifestyle (18) ➢ Unsuitable requirements of salary (16) ➢ Irregular payments (16) ➢ High deductibles (16) ➢ Lower financial bonus (7) ➢ Lower income (7) ➢ Willingness to pay for working in an urban area (7) ➢ Low remuneration (8) ➢ High tuition fees (8) ➢ Lack of economic incentives (26) ➢ Differences between private and public sector payments (26) ➢ Lack of rewards (27) ➢ supplementary income from locum (27) ➢ Economic problems (32) ➢ High fuel costs (45) ➢ Inappropriate payment (33) ➢ Inappropriate salary (33) ➢ Lower reimbursements (34) ➢ Influence of monitoring score on salary (35) ➢ Delay in payments (35) ➢ Low salary(37) | ➢ Income sources (22) ➢ Income expectations (26) ➢ Financing Method (32) ➢ Monthly payment time (33) ➢ Rate of payment (37) ➢ Income (41) |
Career and professional factors | ➢ Group practice arrangement with other clinicians (18) ➢ Opportunities for leadership (18) ➢ Job growth opportunities (19) ➢ Working toward health equity (4) ➢ Promotion prospects status (20) ➢ Providing facilities for phone or email contact with seniors or specialist colleagues for advice (20) ➢ Career development (20) ➢ Professional development opportunity (20) ➢ Functional teams (20) ➢ Autonomy on clinical issues (14) ➢ Professional support (22) ➢ Career opportunities (22) ➢ High professional expectations (22) ➢ Training opportunities (7) ➢ Skills Development (7) ➢ Longer work experience (7) ➢ Scholarship obligation (13) ➢ Autonomy/freedom in the rural practice setting (13) ➢ Recruiting and developing students with an ‘affinity’ for rural communities and services (13) ➢ Educational strategies (8) ➢ Reservation of post-graduate seats for doctors who have served in rural areas (8) ➢ Involving rural doctors in teaching medical students (8) ➢ Arranging continuing education programs for rural doctors (8) ➢ Introduction of compulsory rural service after graduation (8) ➢ Educational investment (8) ➢ Offering professional development opportunities (8) ➢ Educational initiatives to create doctors for rural areas (8) ➢ Selecting medical students who have a rural background (8) ➢ Community-based medical Education (8) ➢ Providing a partial or complete tuition fee waiver in return for rural service (8) ➢ Career Development (27) ➢ Professional or career incentives (27) ➢ Chance to learn new procedures (43) ➢ Rural or underserved postgraduate training (29) ➢ Retainer schemes (29) ➢ Continuing medical education workshops (29) ➢ Initiative Zone Educational Incentive scheme (29) ➢ Financial investment (29) ➢ Graduate in family medicine (31) ➢ Early rural exposure for trainees (45) ➢ Training local students (45) ➢ Educational opportunities (45) ➢ Increasing the number of rural students in local schools (45) ➢ Increasing admissions for rural students (45) ➢ Training and education (36) ➢ Training and purchase of patient-record and information systems (39) ➢ Providing forms of licensure to provide services (39) ➢ Provide forms of licensure to permit rural physicians to cross provincial borders to provide locum services (39) ➢ Career Development Programs (40) ➢ Absence of proper system or policy (40) ➢ Expanding education services (40) ➢ Provision of post-graduation and in-service training (40) ➢ Establishment of medical colleges in rural areas (40) ➢ Continuing medical education (41) ➢ National medical graduate (42) ➢ Accessing higher education (42) ➢ Emphasize on the social aspect of recruitment (42) | ➢ Lack of collegial support among rural general practices (18) ➢ Lack of opportunity to take vacations for personal reasons or continuing medical education (18) ➢ High Professional standards (9) ➢ Specialty and educational requirements and infrastructure (22) ➢ Procedural skills (23) ➢ Shorter job history (7) ➢ Barriers to career advancement (13) ➢ Increasing specialization (25) ➢ Professional isolation (27) ➢ Not having continuing education opportunities (27) ➢ Professional imprisonment (27) ➢ Study leave or international opportunities (27) ➢ Lack of career development guidelines (27) ➢ Educational problems (32) ➢ Poor transportation infrastructure (45) ➢ professional isolation (35) ➢ Lack of promotion opportunities (37) ➢ Feel negative to current job prospects (37) ➢ Seeking better career development (37) ➢ Lack of chance of promotion (37) ➢ Low education level (37) ➢ Limited professional ability (37) ➢ Limited or distant access to specialists and technological support (39) ➢ International medical graduate (42) | ➢ Practice size and type (23, 41) ➢ Long term education (7) ➢ Lack of promotion opportunities (13) ➢ Having an established career path (25) ➢ improvement opportunities (28) ➢ Educational factors (28) ➢ Type of secondary education, and type of higher secondary education (28) ➢ working expertise (31) ➢ Enhanced skills programs (45) ➢ Longer postgraduate training (45) ➢ Midlevel practitioners (34) ➢ Age (37) ➢ Lack of opportunity to use the abilities (37) ➢ Medical training (42) ➢ Changing the medical education model (42) |
Working conditions factors | ➢ Low workload (18) ➢ Regular work hours (18) ➢ level of collegial support (18) ➢ Supervisor level of support (18) ➢ Improvements in information technology (18) ➢ Job flexibility (25, 34, 19) ➢ Supporting systems (19) ➢ Staff function as team (19) ➢ Supportive family and work/life balance (19) ➢ Supportive administration (19) ➢ Effective support staff (19) ➢ Social justice (19) ➢ Developing a locum service to allow rural doctors to take annual leave and sabbaticals (20) ➢ A reasonable level of infrastructure (20) ➢ Working security (16, 20) ➢ A secure working environment (20) ➢ Opportunities for continuing medical education (20) ➢ Compulsory services commitment (16) Educating native manpower (16) ➢ Workplace with a high level of progressive healthcare (9) ➢ Good working environment (9) ➢ Good infrastructure (9) ➢ Rich instrumental background (9) ➢ Reasonable workload (9) ➢ Incentive benefits (9) ➢ Good equipment (9) ➢ Access to medical information and consultations (9) ➢ Opportunities to achieve professional goals (9) ➢ Modifiable characteristics of work (21) ➢ Offering leadership opportunities (21) ➢ Promoting practice ownership (21) ➢ Coordinating cross-coverage arrangements (21) ➢ Professional work (21) ➢ Preference for a location (22) Lack of educational opportunities for children (22) ➢ Work commitments (22) ➢ High career pathways (34) Annual leave opportunities (23) ➢ Business structure (23) ➢ Paid locum relief (23) ➢ Good relations with the supervisor (7) ➢ Increasing level of the facility (7) ➢ Call coverage (13) ➢ Provision of improved working conditions (8) ➢ Improving living and working conditions and environment (8) ➢ Good service infrastructure (25) Educational incentives to promote working (12) ➢ Personal security at workplace (12) ➢ Access to online information technology for bibliographic search (12) ➢ Ability to use new cutting edge technologies (12) ➢ Access to specialist referral network via telephone and web (12) ➢ Adequate infrastructure at workplace (12) ➢ Access to high-complexity regional hospital to refer patients (12) ➢ Contact with medical technology (12) ➢ Rewards and promotion system (27) ➢ support or supervision (27) ➢ Access to the scholarships (27) ➢ ➢ No possibility for contacting a colleague for advice (27) ➢ Organizational incentives (27) ➢ Infrastructure development (27) ➢ Recruiting rural students (29) ➢ Support for professional development or research marketing (29) ➢ Wellbeing or peer support initiatives (29) ➢ Chances for advancement on this job (30) ➢ Appropriate work conditions (30) ➢ The chance to do something that makes use of their abilities (30) ➢ Competence of the manager in making decisions (30) ➢ Work stability (30) ➢ Employment relationship (31) ➢ Fixed office instructions (32) ➢ The specified working hours (32) ➢ Quantity and quality of feedback (32) ➢ Fewer working hours (45) ➢ Immigration policies (45) ➢ Broad scope of practice (45) ➢ Practice opportunities (30) ➢ Positive clerkship experiences (30) ➢ Specific practice opportunities such as teaching, hospital work (30) ➢ Lack of access to electronic medical records (30) ➢ Established relationships with specialists (30) ➢ Security at work (33) ➢ Change management (33) ➢ Political support of the government (33) ➢ Provide needed infrastructure (33) ➢ Organization of practice (35) ➢ Equipment (36) ➢ Social welfare benefits (37) ➢ Growth rate of investment in human resources (37) ➢ Devise retirement incentives specific to rural physicians (39) ➢ Clinical support program (39) ➢ Support staff (41) ➢ Ability to take time off (41) ➢ Group practice (41) ➢ No opportunity for working part-time | ➢ Remaining located far from family and friends over an extended period (18) ➢ Less opportunity for private practice (19) ➢ Inadequate food service equipment (20) ➢ Minimal facilities (20) ➢ Lack of operating room facilities, equipment and blood transfusion services or even basic essential drugs (20) ➢ Mismatch between doctors’ skills and hospital facilities (20) ➢ Long working hours (16) ➢ Lack of job security (16) ➢ High working responsibilities (16) ➢ Local authorities’ bad behavior (16) ➢ Staff’s bad behavior (16) ➢ Improper facilities (16) ➢ Inefficient performance monitoring and evaluation (16) ➢ International medical school graduate (21) ➢ Restrictions on practice location (23) ➢ Lack of labor mobility among physicians (7) ➢ Distance from specialists and medical testing facilities (13) ➢ Adequate equipment (7) ➢ Hard work/long hours (13) ➢ Minimal laboratory and technical support (8) ➢ Lack of enough technological facilities (25) ➢ Socioeconomic characteristics of the designated areas (26) ➢ Income disparities between underserved areas and large cities (26) ➢ Inadequate accommodation facilities (26) ➢ Lack of recreational services (26) ➢ Higher workload (27) ➢ Lack of Mentoring (27) ➢ Absence of library facilities or technical resources (27) ➢ Lack of enough transportation facilities (27) ➢ Inability to use in-service training (27) ➢ Lack of clear incentives (27) ➢ Weak information systems (27) ➢ Systemic and organizational problems (32) ➢ Long working hours (33) ➢ Sharing on-call with only one other physician (34) ➢ Lack of job security (35) ➢ Low amenities (35) ➢ Long working hours (35) ➢ High work risk (37) ➢ Work pressure (37) ➢ Poor work condition (37) ➢ Lack of job safety (37) ➢ Lack the freedom to choose their own method of working (37) ➢ Amount of variety in the job (37) ➢ Industrial relationship between management and workers (37) ➢ Feeling of unsafe job (37) ➢ Continuing medical education (39) ➢ Limiting on-call duty (27) ➢ Compulsory services of doctors in rural health facilities (40) ➢ High ours worked and on-call frequency (40) | Work schedules (21) ➢ Workload (23) ➢ Work hours (23) ➢ Work culture (23) ➢ Hospital Infrastructure (27) ➢ Amount of work (30) ➢ Organization policies (30) ➢ Level of attention by leaders (30) ➢ Workload (45) ➢ Number of referrals for services (35) ➢ Poor work environment (37) ➢ Work hours (37) |
Personal factors | ➢ Supportive family (20) ➢ Self-care while working in high pressure settings (20) ➢ Political stability and security (20) ➢ Desirable family situations (21) ➢ having a personal and family rural background (18) ➢ Older age (22) ➢ Having a rural background (26, 22, 7, 31, 42, 45) ➢ Having a feel for the area (22) ➢ Perceptions of work life balance (23) ➢ Family ties to the community (13) ➢ Being able to help and feelings of patients’ appreciation of the physician (13) ➢ Good partners (13) ➢ Dependence on rural community (13) ➢ Place of residence (13) ➢ Exposure to rural practice before residency program (24) ➢ Marriage to a person from a rural area (24) ➢ Negative opinions about working in rural areas (25) ➢ Family physicians’ reluctance to change locations (25) ➢ Non-monetary incentive policies (25) ➢ Older age (12) ➢ Not having a university-trained professional parent (12) ➢ Previous exposure or service in a poor area (12) ➢ Willingness to practice medicine in rural or underprivileged areas (12) ➢ Interest in serving vulnerable people (12) ➢ Religious beliefs (26) ➢ Positive attitude towards working in remote areas (26) ➢ Lifestyle-related issues (26) ➢ Interest in serving rural setting (27) ➢ Less experience (27) ➢ Rural-origin graduates (28) ➢ Rural place of birth (28) ➢ Parent’s occupation (28) ➢ Occupation of father (28) ➢ Rural health related work experience (29) ➢ Family ties to the region (45) ➢ Residency experiences (30) ➢ knowledge gained during residency of the local community programmers (30) ➢ Being native (33) ➢ Job opportunities for spouses (39) ➢ Work-life balance (41) ➢ Professional interaction (41) ➢ Rural training (41) ➢ Spousal employment opportunities (41) ➢ Importance of finding spousal employment (42) ➢ Raising a family in a rural environment (42) ➢ Alignment of personal culture and skill set with that in the community or practice (42) | ➢ Unsatisfactory rural elective experiences (18) ➢ Family pressure (16) ➢ Having high professional expectations (22) ➢ Placing a high value on prestige (22) ➢ Being bonded and clinical experience (22) ➢ Family and friend closeness (22) ➢ Seeking new employment (7) ➢ Wish to change employment (7) ➢ Being female (12) ➢ Anxiety about the unfamiliarity of rural life (27) ➢ The turnover intention (30) ➢ Being away from family (35) ➢ Willingness to continue education (35) ➢ Spousal and family concerns (39) ➢ Considerations of children (39) | ➢ Personal and professional characteristics (21) ➢ Gender (22) ➢ Specific demographic (23) ➢ Gender (23) ➢ Age (23) ➢ Parental education levels (7) ➢ Birthplace (24) ➢ Year of graduation (24) ➢ The rank of the university attended (24) ➢ Place of residence (24) ➢ Marital status (26, 31) ➢ Individual preferences (26) ➢ Number of children (31) ➢ Year of University entrance (31) ➢ Age (31, 39, 42, 45) ➢ Gender (26, 24, 31, 42, 32, 39, 42, 45) ➢ Family member (37) ➢ Spouse’s career (42) |
Cultural factors | ➢ Gaining an understanding of the needs of people living in rural areas (18) ➢ Patient communication (19) ➢ Patient trust (19) ➢ Quality of doctor patient relationships (14) ➢ Nice people or community (13) ➢ Values (26) ➢ Personal incentives (27) ➢ Target population culture (32) ➢ Deep mutual trust and communication (37) ➢ Lack of social networks and investment in the community (38) | ➢ The misconception that rural practitioners are less qualified than urban specialists (18) ➢ Poor culture of people (16) ➢ Inappropriate treatment of people (33) ➢ Social problems (37) ➢ Cultural differences (38) ➢ Lack of cultural opportunities (42) ➢ High cultural expectations (42) | ➢ Degree of respect and recognition (27) ➢ Relationship with patients (37) |
Living conditions factors | ➢ Suitable housing and access to facilities (18, 23) ➢ Completion of satisfactory electives in rural areas (18) ➢ Provision of adequate schooling for their children or scholarships for boarding school (20) ➢ Jobs for spouses (9) ➢ Suitable places for their children in schools (9) ➢ free housing or subsidized house purchases (9) ➢ Opportunities to enjoy outdoor sports (14) ➢ Access to cultural activities (14) ➢ Lifestyle goals (22) ➢ Having a placement in a rural area (22) ➢ Free housing (25, 7) ➢ Lack of private paying patients (13) ➢ Lack of shopping or restaurants (13) ➢ Access to good schools for children (24) ➢ Social and recreation opportunities (30) ➢ Services in the area and lifestyle opportunities afforded by the location (30) ➢ Education facilities for children (36) ➢ Fit with the community; spouse/partner fit with the community (38) ➢ Appropriate relationships with individuals/community (38) ➢ Attractiveness of a rural location to the spouse (39) ➢ Recreational opportunities (39) ➢ Housing availability (41) ➢ Community incentives (41) ➢ Adequate housing availability (41) ➢ Strong education system for children (42) ➢ Safety of the community (42) ➢ Access to recreational facilities (42) ➢ Activities and proximity to an urban center (42) ➢ Proximity of the location for work and personal lives in a rural environment (42) | ➢ Few social and recreational activities to enjoy (18) ➢ Inadequate accommodation facilities (18) ➢ Separation from partner and family (18) ➢ The absence of phone networks and other forms of communication even post (20) ➢ Lack of opportunities for a social life (20) ➢ Lack of vacation requirements or vacation leave (16) ➢ Region insecurity (16) ➢ Distrust to local authorities (16) ➢ Region depravity (16) ➢ Partner and family considerations (22) ➢ Geographic location (23) ➢ Limiting food choices (8) ➢ Unavailable Telephone services (8) ➢ Social and cultural problems (32) ➢ Environmental problems (32) ➢ Welfare problems (32) ➢ Inappropriate behavior of the people of the area (35) ➢ Political differences (38) | ➢ Size of town ➢ Higher socioeconomic background (7) ➢ Wealth ranking (28) ➢ Population covered area (33) ➢ population growth and urbanization progress (37) ➢ Community size (39) ➢ Current community of residence (42) ➢ Able to grow in [a supportive] environment (42) |