• Helen Ann Latham, Andrew S Maclaren, Johannes H De Kock, Louise Locock, Peter Murchie, and Zoë Skea.
• NHS Highland, Inverness, and clinical research fellow, University of Aberdeen, Academic Primary Care Group, Centre for Rural Health, Inverness, UK.
• Br J Gen Pract. 2025 Feb 12.

BackgroundThe challenges of recruiting and retaining rural GPs are well described. UK data suggest high levels of burnout, characterised by detachment, exhaustion, and cynicism, plays a role in GP turnover. The contrast is engagement with work. There is limited evidence examining the relationship between work engagement and recruitment and retention in rural areas.AimTo qualitatively investigate GPs decisions to move or stay in rural areas through exploring areas that can promote work engagement.Design And SettingThis was a secondary analysis of qualitative data with Scottish GPs.MethodA secondary analysis of 44 semi-structured interviews with GPs from across Scotland was undertaken. Data were analysed thematically and the Areas of Worklife Scale was used to structure data.ResultsFactors associated with burnout were identified and experienced as barriers to moving or staying rurally. Fear of dealing with pre-hospital emergency cases, clinical isolation, and rural training were concerns. Personal factors such as lack of partner employment played a key role in migration decisions. Factors associated with engagement were identified and experienced as facilitators for moving or staying rurally. Professional networks reduced professional isolation and rural GPs valued increased autonomy and time. Many felt being a rural GP was more aligned with their professional values and highly valued the rural lifestyle for themselves and their families.ConclusionOur data suggest that factors associated with engagement and burnout can contribute to rural GPs' migration decisions. We highlight four areas that could promote desirable work environments by mitigating burnout and promoting engagement at work.© The Authors.

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