Medical training pathways and underdoctored areas: a qualitative study of doctors working in areas that struggle to recruit and retain

Some areas struggle more than others to recruit and retain doctors to provide healthcare services. Often, these areas are rural, coastal, remote, deprived or a combination of all these factors, compounding difficulties in access to healthcare; we refer to these areas as 'underdoctored'. This paper aims to describe experiences of working in underdoctored areas, with a focus on exploring why doctors work in these places to highlight what might enable future recruitment. It considers: the routes by which they arrived in an area and the drivers that facilitated those routes; the key stages in participants' lives at which transitions into the area were made; the agency - or lack thereof - that was involved in the choice to work in the area. While previous research has focused on factors driving workforce attrition, we work here to identify what encourages retention, particularly in areas that are known to have difficulties maintaining sufficient medical workforce. Drawing on interviews with doctors who work in these areas across case study sites, we conceptualise how there is a need to understand experiences of working in these areas to surface three intertwined elements - people, career, and place - within a doctors' place-life trajectory. We then explore how one or more of these elements might need to be compromised, how the acceptability of these compromises might change over time, and how the affordances associated with an underdoctored area can be negotiated and re-negotiated in order for those who move to an underdoctored area to want to stay. These findings have implications for improving recruitment and retention, health service provision, and ultimately, health inequalities in these underdoctored areas.