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Investigating the joys and challenges of rural medicine: a student perspective.

Hawai‘i has had a difficult time staffing rural areas with physicians. At present, the neighbor islands have a doctor shortage of at least 15–20%.1 This problem is not unique to Hawai‘i. In the United States as a whole, 20% of the population lives in rural environments, but only 9% of physicians practice in rural areas.2 Internationally, rural communities tend to be underserved by physicians. Currently in rural Canada, an influx of more than a thousand physicians would be needed just to match the physician-per-capita ratio that exists in major centers.3 
 
The reasons for rural physician shortages are diverse. Some factors that inhibit physicians from practicing in rural areas include: professional, social, and cultural isolation; the need for a broader skill set and knowledge base in rural contexts; and the increased workloads that rural practices often entail.4,5 Rural health-care shortages are also compounded by the fact that rural people tend to have lower incomes and poorer health statuses than urban individuals, creating a greater relative need for physicians in rural areas.6 
 
Despite these challenges, thousands of rural physicians serve in communities across North America. These doctors have chosen to work in contexts far removed from the specialized personnel and infrastructure enjoyed by practices in urban centers. An attempt is made in this paper to delve deeper into the mindset of rural physicians, ie, to explore why they chose rural medicine, to learn how they negotiate its challenges, and to understand how they would suggest solving the current general shortage of rural physicians. This article will address the lessons learned while shadowing and interviewing a group of rural physicians.