A General Practitioner (GP) is usually the first doctor that people see about a health issue in Ireland. If a specialist is required for an assessment, the GP is usually responsible for referring this patient.

In some ways, working as a GP in rural Ireland is similar to working as a GP in one of the country’s bigger cities, such as Dublin, Cork, Galway or Limerick.

After all, people largely experience the same ailments in the city as they do in the countryside; for instance, bronchitis in Cabra requires the same treatment as it does in Connemara.

However, there are some standout differences you should be aware of before you make the decision to locate your practice in one or the other.

 

Community Involvement

Doctors within rural areas are often well-known figures, encountering a set base of service users, whom they share the local community with.

This is opposed to the relative anonymity that a GP can attain outside of work hours in a large city.

Of course, GPs within both urban and rural areas often feel ingrained and invested in the future of their local communities. However, the absence of other GPs and services in a rural area can lead to these doctors being viewed as essential pillars within a locality, providing ongoing care to locals throughout their lifetimes.

Dr Margaret O’Riordan, a former Medical Director of the Irish College of General Practitioners, discussed the differences between the areas in the report, ICGP Vision for the Future of Irish Rural General Practitioners.

The following passage discussed the rewards of working in these rural areas: “Rural General Practice can be a very rewarding career with the opportunity to practice comprehensive patient centred continuity of care for a defined group of patients. Rural Practice also entails the use of a broad range of skill sets in often challenging situations.”

 

Different Types of Care

It is true that the rural-urban divide can lead to different types of care being administered.

The international view is similar to this, with research done by the University Medical Centre Hamburg-Eppendorf, echoing this sentiment: “Urban GPs perceived themselves as a provider of medical services and rural GPs as being a medical companion.”

This research also added that rural GPs may be at an advantage when it comes to the relationship formed with their patients, adding: “Rural GPs establish a close relationship with their patients and consider this as beneficial for the treatment relationship. This aspect seems to play a subordinate role for urban GPs.”

 

Different Challenges

Like every other element of life, working in a city as a GP provides different challenges to working as a GP based in the countryside. There are social issues which aren’t as frequent in rural areas and your surgery may be home to a much larger population base.

In terms of rural challenges, a recent study showed that just seven percent of rural patients live within walking distance of their GP in rural areas, compared to 89% of those in more urban areas, according to a 2010 study.

This is an issue that can lead to a general practice that is more mobile, with outside visits a more frequent occurrence.

 

Depopulation In Rural Ireland

Depopulation within certain parts of rural Ireland is also a serious issue, particularly with young people.

A Leitrim politician, Sean McDermott highlighted this issue in an interview with AgriLand.

He said: “In my neighbouring parish of Kiltyclogher, in recent times there have been 15 deaths over a nine-month period there and no births. Alarm bells should be ringing there – that statistic is frightening.”

The ICGP report pointed towards this issue: “There are reductions in social interactions for all members of rural communities and in particular for the elderly.”

Rural GPs are dealing with the effects on those who are left behind; an ageing population with physical and mental health issues.

There are also issues surrounding ambulance support and pre-hospital emergency work for rural GPs. Those in urban areas are simply not faced with that level of challenges.

 

The Future

In May 2019, the then Minister for Health discussed the future of primary care and mentioned both the issues within rural and urban areas.

At the time, he said: “For its part, the Government has committed to increasing investment in general practice by €210 million, or approximately 40%, over the next four years.”

He added: “There will also be increased support for rural practices and for those in disadvantaged urban areas.”

There is little doubt that there are many challenges to both, but there are also many rewards.

Rural practices give you the option to be a part of a community, offering badly needed support to locals. Meanwhile urban practices allow you to be at the epicentre of activity and enjoy a more varied base of patients with different issues.

Hopefully with increased investment, both rural and urban GPs will have satisfactory support to continue to engage with communities that badly need their care.