Table 2:

Summary of themes and categories

Factors attracting physicians to rural areasCommunity factorsAttracted to rural lifestyle; quality of life; valued contribution or work in the community
Financial incentivesMonetary and nonmonetary incentives
Personal and family-related factorsAccess 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with rural or remote practiceChallenges related to patient careComplex patient panel; limited access to specialists; outdated or old equipment or facilities
Community challengesCold or severe climate; cultural or ideological differences; community pressures
Family-related and personal factorsSeason of life needs; spousal factors; work–life balance
Practice and professional challengesKeeping up with clinical knowledge; high on-call burden; travel-or professional-related barriers
Potential role of APMs in recruitment and retentionAbility 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 concernsFair 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 concernsDifficulty in administration; financial losses associated with changing payment models
Peculiarities of rural practicePopulation fluctuations; travel costs
Physician perspectives on payment modelsImpact on patient care and physician practiceAPM 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 impactsAPM: income security; paid vacation time; potential cost savings
FFS: under pressure for income to keep practice running; income less stable
Potential for perverse incentivesAPM 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.