Community and self: concepts for rural physician integration and retention

Low physician availability in rural areas of the United States is a long-standing issue. While most research has focused upon the locational decisions of physicians to understand the causes of the problem, a relatively new and neglected research focus is the retention of rural physicians. This paper takes the perspective that integration of physicians within rural communities is the basis for retention. It introduces concepts of self and community as a basis for understanding "domains" of rural physician integration. From data collected during in-depth qualitative research in rural Kentucky, a framework of integration domains is developed. The three domains of physician self, medical community, and community-at-large are elaborated with examples from the data. To further explain the relationships among the integration domains and their value, the findings are combined with three concepts from social theory. Social capital, core participation, and community reconstruction add dynamic and meaningful aspects to the context in which integration and retention occur, and they provide a conceptual basis to use when investigating or devising actions to facilitate integration.