‘Mind the professional gap’: exploring how doctors experience working in peripheral areas

Background - The shortage of medical professionals in peripheral areas is an international challenge, not only in the developing world but also in developed countries. This jeopardises the quality and equity of care provision. Recent scholarship has started to investigate the factors that encourage doctors to practice in rural settings, but further research is required to address some shortcomings (Holloway et al., 2020). This exploratory study aims to expand current literature by specifically focusing on the professional and organizational factors that shape doctors working experience in peripheral areas. Methods - By adopting a qualitative research approach and drawing from the literature on medical professionalism, we aim to gain a deeper understanding of the multifaceted nature of professional drivers shaping at the individual level the experience of doctors working in peripheral areas, as well as the organizational factors supporting or hindering their motivation. We performed 22 interviews with professionals and managers in four Italian local health authorities managing small-sized hospitals in peripheral areas. Results - The findings from this study present intriguing insights that invite a reconsideration of the work experience of doctors in peripheral areas through the tenets of professionalism. The professional factors identified by the study unfold within a nuanced trade-off of ambiguity, wherein factors typically associated with preferences for urban working environments, like teaching hospitals and hubs, surprisingly unveil implications and advantageous prospects for peripheral work settings. This suggests the need to reconsider and broaden our understanding of the factors influencing professionals'work experience in peripheral healthcare settings, recognising that what may conventionally be seen as factors favouring complex and urban hospitals can present unique advantages when applied to peripheral contexts. Furthermore, the study identifies specific organizational factors that might support or hinder the individual perceptions of professional needs in peripheral areas. Conclusions - The paper provides intriguing opportunities for tailoring employment propositions for professionals. Our research shows that policymakers and public healthcare managers should acknowledge a more nuanced scenario and craft policies specifically tailored to peripheral organisations, carefully considering professional needs.