title: Sustaining the rural primary healthcare workforce: survey of healthcare professionals in the Scottish Highlands.
abstract: BACKGROUND
  Many westernised countries face ongoing difficulties in the recruitment and retention of health professionals in remote and rural communities. Predictors of rural working have been identified by the international literature, and include: the individual having been born or educated in a rural location; exposure to rural healthcare during training; access to continuing professional education; good relationships with peers; spousal contentedness; adoption of a rural 'lifestyle'; successful integration into local communities; and educational opportunities for children. However, those themes remain unverified in the UK. The present study aimed to ascertain whether the internationally identified determinants of recruitment and retention of the rural health workforce apply in the Highlands of Scotland, which includes the most sparsely populated area of the UK mainland, as well as an urban area.
  
  
  METHODS
  In 2003, a questionnaire was sent to all 2070 primary healthcare professionals working in the Highlands (which makes up one-third of Scotland's land area (9800 square miles) and has just 4% of the country's population (209,000)). Approximately one-quarter of the Highland's population live in Inverness. The area is ideal for investigating the rural workforce due to its population sparsity and the inclusion of small towns and Inverness, allowing urban/rural comparisons. The questionnaire asked about places of birth and education; intentions to stay/leave current location; professional isolation; access to amenities; and perceptions of belonging to the local community.
  
  
  RESULTS
  The response rate was 53%. Compared with respondents working in urban areas, those working in rural areas were more likely to have been born in rural areas. Professionals living in rural areas were more likely to have been born outside Scotland and to have completed their secondary education and professional training outside Scotland, compared with those living in urban areas. Approximately one-third (34%) had lived in their current location for more than 10 years, and that proportion was higher for the urban group compared with rural dwellers. Similarly, the urban dwellers were more likely to have been in their current job for more than 10 years. Respondents' perceptions of being isolated, of their caring roles extending beyond their work; and of an inability to get away from work for holidays and study leave, were more common among rural dwellers. Eighty-one percent of respondents said that they felt part of their community and that proportion was higher for those working in rural areas, than for urban residents. Respondents indicated their perceived ease of access to five amenities and services: children's education (preschool, primary and secondary); access to a job for spouse; and health care. With the one exception of access to primary education, access was perceived to be most difficult by the professionals working in rural areas.
  
  
  CONCLUSIONS
  Our survey confirms, in the UK, the association between rural background and rural working, and highlights the contribution of healthcare professionals from other parts of the UK to the Scottish rural workforce. It also suggests that professional isolation and perceived lack of access to amenities are important issues for those working in rural areas.
authors.affiliation: Centre for Rural Health, Aberdeen University, Beechwood Park, Inverness, Scotland. h.richards@abdn.ac.uk
authors.forename: Helen M
authors.initials: HM
authors.lastname: Richards
authors.forename: Jane
authors.initials: J
authors.lastname: Farmer
authors.forename: Sivasubramaniam
authors.initials: S
authors.lastname: Selvaraj
mesh_terms: D000328:Adult; D002321:Career Choice; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D010560:Personnel Selection; D011153:Population; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D019035:Rural Health Services; D012606:Scotland; D012934:Social Isolation; D011795:Surveys and Questionnaires; D000078329:Workforce