Strategies for the Migration of Physicians to Remote and Rural Areas (on the example of Tver region)

Abstract

The article identifies five strategies for migration to rural and remote areas of Tver region. The study is based on biographical interviews with fifteen medical doctors who have moved to the periphery as well as on interviews with eight experts in the field of health governing. The revealed strategies result from the interplay between push and pull factors of migration and socio-demographic profiles of migrants. The strategy "Be of use in the place where you were born" is linked with a return migration, particularly if doctors come back to their hometown after graduation from the university because of a lack of resources for life in a big city and the presence of intergenerational transfers."Decembrist wives" — is a strategy of following the spouse to the periphery. Relocation of the "Enforced immigrants" is caused by war, economic or family crisis in their home. Guided by the "Careerists" strategy, young doctors from big cities and capital areas are attracted by opportunities for gaining professional experience, while doctors of middle and pre-retirement age are interested in the promotion to the high-level administrative positions. The "Desire of a million" strategy is characterized by receiving material rewards such as housing or compensation payments. At the same time, doctors from big and capital cities often choose to commute between the place of work (which is their official place of residence along with the rules of participation in the “Zemsky doctor” federal program) and the actual place of residence. Doctors who have experienced living in small towns and rural areas often tend to move to the periphery on a permanent or temporarily basis. For them it is associated with lower costs of living — the existing programs allow them to improve the level of life and living conditions. In turn, all these factors increase the likelihood of such doctors becoming entrenched in the periphery.

Acknowledgments. The study was carried out as part of the HSE University Program of Basic Research in 2021.