Motivations and challenges experienced among locums working in Norwegian rural general practice: a reflexive thematic...

To further our understanding of temporary work and rural healthcare services by exploring doctor's motivations for, and experiences with, locum work in Norwegian rural general practice.

Individual semi-structured interviews were conducted with general practice locums who were currently working or had recently worked in a rural area. Audio recordings from the interviews were transcribed verbatim and analysed using reflexive thematic analysis.

Locums in rural general practice were often recruited by third parties (agencies or colleagues). Early career locums usually found it easier to use agencies. Most of the locums were attracted to temporary work for the work-related autonomy, work-life balance, interesting locations (locum tourism) and attractive salaries. Experienced locums emphasised work-life balance and clinically focused work, while early career locums often sought to accumulate work experience. All locums reported being under high expectations to perform independently, often with minimal formal support. Early career locums expressed a desire for formal support to compensate for their limited experience. To maintain continuity of care, locums used longer consultations and wrote detailed notes in the electronic patient records.

In light of recruitment and retention-challenges in general practice it is worth reflecting on the results that many locums were attracted to rural general practice by the combination of high salaries, better work-life balance and time for clinically focused work. In addition, locum work offered valuable clinical experience for early career locums. On the other hand, locums experienced discontinuity of patient care, high expectations to perform, considerable responsibility and minimal formal support. There is a need to explore how to improve formal support, such as standardising introductory programmes and providing mentoring sessions, especially for early career locums, and how to adapt work routines to strengthen continuity. In light of our results, we question the wisdom of maintaining lower qualification requirements for doctors taking temporary contracts as a measure to increase locum recruitment in rural and remote areas.