Working in rural and peripheral hospitals is often seen as a professionally unattractive option for doctors. However, a recent study shows that factors typically perceived as disadvantages in these settings, such as managing a wider variety of cases rather than specializing, or having fewer colleagues, can actually turn into professional assets and strengthen doctors’ motivation.
Take, for instance, the case of a physician in the Apennines near Bologna who recently made headlines for choosing a general practitioner position in Castiglione dei Pepoli (691 m, population 5,471) over a job in Switzerland. In an interview with Corriere Bologna, he explained: “We doctors in mountain areas end up having a social role; we’re a point of reference (...). People know each other here (...). They even invite me to their important life moments. I was recently invited to a couple’s 60th wedding anniversary.”
According to the research, similar dynamics apply to hospital positions as well. Factors like autonomy, competence, purpose and visibility can always be viewed ambivalently. Clear disadvantages in peripheral areas often come with less obvious—but very real—benefits, which can be leveraged to make these hospitals more attractive.
Department heads and healthcare managers should not rely solely on financial incentives or logistical support. Rather, it is crucial to understand and enhance the unique professional experiences offered by these contexts, while ensuring adequate organizational support.
The context
The shortage of healthcare professionals in rural and sparsely populated areas is a well-known issue worldwide, affecting both developing and advanced countries. In Italy, a quick online search reveals many public calls for hospital doctors in rural or isolated areas of many regions that have gone unanswered in Liguria, Molise, Piedmont, Veneto and Basilicata among others.
Recently, the Tuscany Region responded with job postings offering permanent medical roles with “an addendum containing exclusive clauses in addition to standard contractual conditions.”
Academic literature has started to explore the factors that lead doctors to work in non-urban areas. However, most studies have focused on rural or remote settings in vast territories, such as Australia or the Nordic countries, while largely overlooking peripheral hospitals in developed, densely populated countries.
In this study, “peripheral areas” refers to zones with low accessibility and lower population density compared to urban centers, often regarded as marginal from a professional standpoint as well, given that high-quality care tends to concentrate in large hubs. The research focuses on the professional and organizational factors that shape the work experience of doctors in these settings. The main question: how do doctors perceive their work in peripheral areas, and what organizational conditions influence their motivation and professional experience?
The research
The study, conducted within the OASI Observatory at CERGAS SDA Bocconi, draws on the literature on medical professionalism and integrates insights from the self-determination theory. Using a qualitative approach, the researchers conducted 22 semi-structured interviews in 2023 with a mix of healthcare professionals and managers from four Local Health Authorities (ASLs) in Italy. These ASLs manage small to medium-sized hospitals located in peripheral or suburban areas. The chosen specialities, Orthopaedics and Cardiology, are commonly found even in smaller hospitals.
The interviews explored what motivates professionals in peripheral contexts and what factors shape their working experience. Researchers identified four key professional dimensions that influence doctors’ perceptions: autonomy, competence, purpose, and visibility. Each of these factors carries both potential benefits and drawbacks, depending on the specific experience.
For example, working in a smaller hospital may lead to professional isolation (due to fewer peers for discussion), but it can also offer more decision-making autonomy and the chance to quickly become a trusted figure. Likewise, while less complex cases may limit specialization, the diversity of procedures provides on-the-job learning and opportunities to build a broad or niche skillset. At the same time, organizational factors emerged that can either reinforce or weaken these individual professional experiences.
Conclusions and takeaways
When properly leveraged by department heads and healthcare managers, the professional ambiguity typical of peripheral settings can become a powerful tool to build attractive value propositions. It is important to recognize that doctors are driven by the ability to apply, develop, and gain recognition for their skills. Creating opportunities to cultivate specialized niches, pursue professional growth and gain social recognition is a strategic investment.
In this regard, the role of the department heads is fundamental. They must combine technical skills with vision, training capabilities, and strong interpersonal qualities in order to build professional networks and customized career development pathways. Examples of actions that can help make peripheral hospitals more attractive include: inviting external specialists to collaborate with local doctors; sending staff to larger central hospitals to acquire new techniques and competencies; promoting partnerships with other healthcare facilities; establishing relationships with universities to attract and retain medical residents; and enhancing doctors’ visibility by allowing them to pursue private practice opportunities.
Marco Sartirana, Giorgio Giacomelli, Francesco Vidè, Claudio Buongiorno Sottoriva, “‘Mind the professional gap’: exploring how doctors experience working in peripheral areas.” BMC Health Services Research, (2025) 25:594. DOI: https://doi.org/10.1186/s12913-025-12672-2.
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