The challenges and rewards of rural family practice in New Brunswick, Canada: lessons for retention.

INTRODUCTION This study examined the work environment of rural family physicians in New Brunswick, a province in eastern Canada. The purpose of the research was to explore the job satisfaction of rural family physicians based on gender, age, years in practice, and language and location of practice. METHODS We used a qualitative, collective case study approach (24 cases of two individuals each: 48 interviews). Cases were selected based on gender, location (urban/rural), language (French/English) and number of years since medical school graduation (<10 years, 10-20 years, >20 years). The data reported is based on 21 interviews with rural physicians. Participants were recruited using the College of Physicians and Surgeons of New Brunswick website information. The research team traveled to physicians' offices throughout the province of New Brunswick to conduct interviews in the language of preference of the physician (French or English). Male researchers interviewed male participants and female researchers interviewed female participants. Interviews were transcribed verbatim and analyzed for themes related to the benefits and challenges of rural practice. Consensus on themes was reached among the entire research team. RESULTS Many rural practitioners face a host of challenges ranging from professional isolation, complex patient profiles and maintaining professional boundaries. In this study, the most important challenge rural family physicians faced was the non-clinical issue of boundary maintenance. When rural family physicians had difficulties maintaining boundaries they were more likely to consider leaving their rural practice. Overall, few differences, based on gender, age, years in practice and language of practice were found. A few rural family physicians felt that the benefits of rural practice outweighed the challenges. CONCLUSIONS This study demonstrates that rural family physicians in the province of New Brunswick, Canada face numerous challenges while practicing in rural areas. The most important challenges are not medical or technical in nature, but the 'soft' issue of maintaining professional and private boundaries. Rural physicians, when off duty, want privacy. Rural family physicians have to become more assertive about their needs, while at the same time, patients have to realize that off-duty physicians are private citizens.