"Kind of Feel Like the Lone Outpost": A Qualitative Exploration of Barriers to Professional Development for Rural...

Ongoing professional development (PD) is vital to high-quality healthcare, workplace satisfaction, and the retention of rural primary care providers (PCPs). However, the barriers to PD experienced by rural PCPs remain underexplored. This evaluation examined barriers to PD engagement among rural Veterans Health Administration (VHA) PCPs.

A descriptive, cross-sectional qualitative design was employed to explore barriers to PD participation. Participants included nine rural VHA PCPs, six ambulatory care leaders, and three facility leaders. Recruitment continued until data saturation was reached. Rurality was determined using Rural-Urban Commuting Area (RUCA) codes. Semi-structured interviews and focus groups were conducted, recorded, transcribed, and analyzed using a rapid qualitative framework approach.

Participants represented diverse rural regions and disciplines. PCPs included physicians, a nurse practitioner, a physician assistant, and a pharmacist. Six themes emerged as barriers to PD: (1) ineffective or delayed communication of PD opportunities; (2) rural clinic capacity constraints, including understaffing with inadequate patient coverage and insufficient protected time; (3) high opportunity costs; (4) limited geographic access; (5) professional isolation; and (6) perceived devaluation of the PCP role.

This qualitative evaluation provides new insight into how rurality and its associated barriers influence access to and engagement in professional development among rural PCPs. Findings highlight the need to improve communication, ensure protected time, and expand access to PD while mitigating professional isolation. Understanding these barriers is crucial for designing feasible interventions that enhance PD engagement, strengthen the rural workforce, and improve quality of care for rural Veterans.