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CMAJ Open. 2017 Sep 12;5(3):E710-E716. doi: 10.9778/cmajo.20170075.

Working hard but working differently: a qualitative study of the impact of generational change on rural health care.

Author information

Affiliations: Department of Family Practice (Snadden, Alexander), Faculty of Medicine, University of British Columbia, Vancouver, BC; Northern Medical Program (Snadden), Prince George, BC.



There is limited literature evaluating generational change in the physician workforce and the adjustments required of practices, practitioners and the health care system as a whole. The purpose of this study was to explore rural practitioners' experiences of their current contexts relevant to recruitment and retention and to determine how practices are responding to changing aspirations of new practitioners.


We used qualitative methods. Participants were selected to ensure diversity of career stage. Semistructured interviews conducted with 39 physicians, 2 nurses and 1 practice administrator from rural northwestern Canada (British Columbia, the Yukon Territory and the Northwest Territories) between June and October 2016 sought participants' views on research, training, recruitment and retention in the rural setting. Interviews lasted 30-50 minutes with the exception of 4 group interviews (45-90 min). Interviews were then conducted with 4 rural practitioners on Vancouver Island to confirm emerging themes. The interviews were recorded and analyzed interpretively.


Three themes were identified that showed the interplay among practitioners, patients and resources within a rural health environment: 1) scope of practice and the changing concept of generalism, 2) connectivity and relationships and 3) divergent career aspirations. Within these themes, generational differences between early-career physicians and established practitioners influenced changes under way in rural practice in terms of adapting the practice environment to enhance recruitment and retention.


Some rural practices are beginning to adapt in ways that reflect changing generational aspirations. Specifically, they provide environments that support and nurture young physicians, encourage collaborative working and include flexible working arrangements, with varying support and financial models. Rural practices that were responsive to changing aspirations reported success in recruitment and retention.

Conflict of interest statement

Competing interests: David Snadden is the Rural Doctors' University of British Columbia Chair in Rural Health, which is funded by an endowment from the Rural Doctors of British Columbia through the Joint Standing Committee on Rural Issues. This research was supported by the chair's operating funds. No other competing interests were declared.

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