I'll start, and I'll let Dr. Ballagh add his comments.
I think its multifactorial, just as you referred to. I think part of it is that when you work in a rural community—and I have colleagues who do that; they work very hard. They don't tend to get home in time for supper at five or six o'clock at night because they're the only ones in town. They're on call on a much greater frequency, often one in one.
The other thing is that there are greater demands on them. If they work in a larger community, they have the resources of specialists to fall back on; if something is getting a little out of their territory, they know they can pass it on to someone with greater expertise. When you're in a small, remote community, you don't have that, and it's all on your shoulders. That's a stress that a lot of people don't feel comfortable with.
I also think some people in some communities feel they don't have the infrastructure to support their needs very well medically. They fall to levels of frustration because the dollars aren't there to support something such as setting up better telehealth systems to have specialists work remotely.
I think after a while, unless they're very dedicated, they plan to go. It's a small percentage of these rural physicians, but that's what the Society of Rural Physicians of Canada has documented within the members of its group.