Summary of themes and categories
| Themes | Subthemes | Categories* |
|---|---|---|
| Factors attracting physicians to rural areas | Community factors | Attracted to rural lifestyle; quality of life; valued contribution or work in the community |
| Financial incentives | Monetary and nonmonetary incentives | |
| Personal and family-related factors | Access to child care; retirement plan; previous personal rural experience; spousal factors | |
| Professional factors (motivators) | Autonomy or independence; patient–physician relationships; variety in the scope of practice | |
| Barriers and challenges associated with rural or remote practice | Challenges related to patient care | Complex patient panel; limited access to specialists; outdated or old equipment or facilities |
| Community challenges | Cold or severe climate; cultural or ideological differences; community pressures | |
| Family-related and personal factors | Season of life needs; spousal factors; work–life balance | |
| Practice and professional challenges | Keeping up with clinical knowledge; high on-call burden; travel-or professional-related barriers | |
| Potential role of APMs in recruitment and retention | Ability to share workload with allied health care workers on an APM; APM could attract new physicians | |
| Factors that physicians consider in decisions around payment model changes (factors that influence physician preferences for APMs) | Contract concerns | Fair contracts; potential to earn less; fear of loss of autonomy and flexibility; feasibility of one payment model for all types of clinical work; involvement of physicians in payment model design |
| Implementation concerns | Difficulty in administration; financial losses associated with changing payment models | |
| Peculiarities of rural practice | Population fluctuations; travel costs | |
| Physician perspectives on payment models | Impact on patient care and physician practice | APM impacts: enables holistic patient care; more time with patients; potential loss of physician autonomy FFS impacts: improved patient access; tendency to have more follow-ups; tendency to spend shorter periods with patients |
| Remuneration impacts | APM: income security; paid vacation time; potential cost savings FFS: under pressure for income to keep practice running; income less stable | |
| Potential for perverse incentives | APM impacts: loss of drive to innovate, improve or see patients; “free rider problem” FFS impacts: might incent some physicians to see too many patients |
Note: APM = alternative payment model, FFS = fee-for-service.
↵* Bolded categories represent categories most commonly mentioned or most important.