title: "If only someone had told me…": lessons from rural providers.
abstract: OBJECTIVE
  Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers' knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains.
  
  
  METHODS
  Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, "What are the 3 things you wish someone would have told you about delivering health care in rural areas?" were thematically coded.
  
  
  RESULTS
  Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner.
  
  
  CONCLUSIONS
  Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services, and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities.
authors.affiliation: Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, Alaska 99508, USA.
authors.forename: Cody
authors.initials: C
authors.lastname: Chipp
authors.forename: Sarah
authors.initials: S
authors.lastname: Dewane
authors.forename: Christiane
authors.initials: C
authors.lastname: Brems
authors.forename: Mark E
authors.initials: ME
authors.lastname: Johnson
authors.forename: Teddy D
authors.initials: TD
authors.lastname: Warner
authors.forename: Laura W
authors.initials: LW
authors.lastname: Roberts
mesh_terms: D000413:Alaska; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D008019:Life Style; D009516:New Mexico; D024382:Professional Role; D011369:Professional-Patient Relations; D019035:Rural Health Services; D012648:Self Care; D012959:Socioeconomic Factors