A unique database to provide evidence for solution development David Heaney

Firstly.... Acknowledgements to Icelandic partners, Birgit Abelsen, Andrew Sim, and Gerry King In many cases the numbers are too small to be significant so we are reporting trends only. Based on percentages rather than numbers which can also skew the results. When looking at ‘level of agreement’ we took responses from ‘agree’ and ‘strongly agree’ as positive and ‘disagree’ and ‘strongly disagree’ as negative.

The urban / rural divide The majority from all of the countries agree that communities of 25 – 100,000 inhabitants are urban and communities of 2 – 5,000 inhabitants are rural. Canada is the only country which considers 10-25,000 inhabitants as rural. Greenland, Iceland and Sweden consider 5 – 9,999 inhabitants as urban whereas all other countries defined this as rural. This distinction is important for understanding the answers to other questions and for context.

Isolation Isolation is variable– especially with regards to professional and geographical. The responses on isolation are strongly correlated. This means that those who experience professional isolation simultaneously experience social, cultural and geographic isolation. Religious isolation was not identified as an issue by the large majority of respondents from all of the countries. isolation is associated with the rural experience. Participants from Norway and Sweden are less isolated More than half of all rural respondents from Canada, Greenland and Scotland experience geographical isolation Seventy six per cent of the Greenlanders experience geographical isolation.

Affiliation and involvement The majority feel part of their community, and the majority would like to collaborate with other residents to improve it. Inhabitants of Greenland were less likely to want to collaborate with other residents in this way. The probability that one will collaborate increases if one works in a rural area. However, those in rural Greenland indicated that they felt less a part of their community than those in urban areas.

Stability and plans for job change It is unlikely respondents will look for another employer in all of the countries except rural Greenland. Those from Greenland indicated that they were the least settled in their jobs. Respondents from rural Scotland, Ireland and Canada indicated that they were the most likely to stay in their jobs in the short term and in the long term.

Why health care professionals leave jobs in rural areas Excluding Greenland, there were less than ten percent who over the last 12 months had left a vacancy in a rural area. Physicians, men, the youngest and oldest age groups, and those of urban origin were more likely to have left their job. However, one in two still working in rural areas and most were also living in a rural area. Those who had quit were asked how important various possible reasons for this were. Work-related reasons such as Limited career opportunities and Limited professional support was amongst the most important, while most important aspect outside of work was Family reasons.

The Ideal job in a hospital in an urban area (35%) primary care in a rural area (23%) primary care in an urban area (20%) 41% ideal job was in a rural area doctor, has a rural background, and if he/she has undertaken parts of their health education in a rural area. Times three in Norway most important to ideal job was job satisfaction, good teamwork, and balance between work and leisure. Sweden and Highland were most likely to want to work in primary care in a rural area, Canada and WI were most likely to want to work in a hospital in a rural area. Working in primary care in an urban area was most favoured by Ireland and working in an urban hospital by those from Greenland, Iceland and Norway..

What is important outside work Leisure, affordable housing and friends and family were the most important factors, while child care availability and public transport was least important. Ireland and Iceland differed in what was most important to respondents; they prioritised travel costs and schooling. Fewer of the rural dwellers see factors as important as the urban dwellers. For example, 46% of urban dwellers rated entertainment as important whereas 27% of rural dwellers agreed. Similarly, 48% of urban Norwegians rated ‘shopping’ as important compared with 28% rural Norwegians.

Highly Important Approaches to work Colleagues respecting my jobUrban>Rural Approaches to work Wages are importantUrban>Rural CommunityI feel part of the communityUrban>Rural Factors considered when starting your present job The post suited my educationUrban>Rural In your current situation do you have:Leisure activitiesUrban>Rural In your current situation do you have:ShoppingUrban>Rural In your current situation do you have:Access to entertainmentUrban>Rural

Less Important Factors considered when starting your present job Financial remunerationRural>Urban Factors considered when starting your present job Availability of leisure activitiesRural>Urban Factors considered when starting your present job Spouse was raised in the areaRural>Urban IsolationProfessionalRural>Urban IsolationGeographicalRural>Urban RuralRural placements during trainingRural>Urban RuralRural residence during educationRural>Urban When moving to another job Poor reputation of employersRural>Urban Factors considered when starting your present job There were limited appointments elsewhereUrban>Rural

Not important IsolationCulturalRural>Urban IsolationSocialRural>Urban IsolationReligiousRural>Urban

Notes of interest Greenland participants appear to be the least settled/happy. Participants from Sweden and Norway present as having the least problem with isolation. Reputation of employer The results indicate that for your ideal job to be rural, the rural aspect has to be experienced beforehand. Norway X3.

Why Recruit and Retain is different Transnational co-operation Iceland, Norway, via UAE, Scotland Combination of international data sources Status reports and interviews were also key Used to develop products and services There is more work to be done to present findings