Family doctors in inland areas: a choice between depopulation, community and technology

However, there is no shortage of difficulties. Far from the specialist centres 'there are many more margins of uncertainty, because access to diagnostics is more difficult and it is more complex to request consultations'. Technology comes to the rescue: 'Having fewer possibilities to hook up second-level examinations, we make a virtue of necessity and try to compensate with the means available, such as telemedicine and remote diagnostics'. In some regions, such as Emilia-Romagna, consultations with specialists can take place in real time; in Sardinia, on the other hand, 'we are far behind on this front'.

The day does not end when the door of the surgery closes at 8pm. The paperwork and the mental workload remain. 'But don't call it a mission,' Contu concludes, 'this narrative is no longer correct. Better to call it a life and professional choice.

The community dimension also emerges strongly in Spain. Antonio García Navas, 57, a family doctor and representative of primary care physicians at the College of Physicians of Cadiz, has worked in both urban and rural areas. After an initial experience in the city, he chose rural medicine in the early 2000s, attracted by greater work continuity. Today, he works in Paterna de Rivera, a municipality of just over 5,500 inhabitants, about 40 minutes' drive from Cadiz.

"The big difference between urban and rural medicine," he explains, "is the community component. In rural areas the longitudinality of care increases: patients are followed over time, more home visits are made and many emergencies are managed directly. The social determinants of health, from the loneliness of the elderly to youth unemployment, also become more evident.

In the centre where García Navas works, three doctors work, with morning and afternoon shifts, nights on the premises and one weekend per month. Rural paediatrics is one of the critical nodes: "Many paediatricians do not want to work for long in isolated settings. Here, too, technology is changing the work: teleconsultations and ultrasound scanners in peripheral centres allow previously unthinkable diagnoses. And despite everything, 'professional satisfaction is often higher than in urban medicine'.

The theme of the periphery also runs through training. Carmen S. Bueno, radiologist, left Malaga to do her specialisation in Don Benito, Extremadura. "I knew that to choose the speciality I wanted I would have to leave. An experience initially lived with ambivalence, but which contributed to her professional and personal growth. Like many other residents, however, she always considered this phase as temporary, with the aim of returning to her home town.

Distance takes on an even different dimension in the Greek islands. In Kardamyla, a village on the island of Chios, being 'the teacher' or 'the doctor' often means losing one's name and being identified only with one's role. Community respect coexists with an emotional distance: one is perceived as a temporary figure, destined to leave. The departure of the last means of transport of the day - bus or ferry - marks the moment when isolation becomes tangible.

A feeling also shared by many doctors. "In a small town you live in a glass house," says a doctor who prefers to remain anonymous. "Everyone recognises you, but no one really knows you." When you close the front door, the contrast is stark: from the adrenalin rush of the clinic to the absolute quiet of the village. Even the digital connection only partially helps: 'Sometimes it amplifies the distance and makes you feel like a spectator of your own life'.

*This article is part of the European collaborative journalism project "Pulse"