A comparative study of rural clinics in remote islands and inland areas

The social and professional isolation of physicians remains an important issue in rural areas. However, few studies have investigated the involvement of geographic factors in the isolation. This study investigates rural public clinics in inland and remote island locations and attempts to objectively compare the isolation of these physicians. A mailed questionnaire was sent to rural clinics where graduate physicians from Jichi Medical School were working in 1994 and 1995. Among the 198 clinics with one or more full-time physicians, 185 (93 percent) responded to the inquiry. Geographic and demographic factors of the communities were compared between 43 clinics located in remote islands and the other 142 rural inland clinics. Rural clinics in remote islands have smaller subject populations, fewer part-time physicians, a longer journey to the nearest city, and a longer distance and travel time to the base hospital than rural inland clinics. Physicians in remote island clinics had less medical training and are more isolated than other physicians. More than half of the clinic physicians in remote islands have no regular training schedule, in contrast to less than a quarter of the inland clinic physicians. Almost all clinics (97.7%) in remote islands do not have a part-time physician, whereas about 20 percent of the rural inland clinics do. Physicians in remote island clinics are more socially and professionally isolated than those in inland clinics. Strategies to reduce these problems should be given priority in rural health policy and measures tailored to rural clinics in remote islands.