Negotiating the Gemeinschaft/Gesellschaft Dichotomy: Appalachian Medical Student Perceptions of Practice☆

This study investigated motivations for Appalachian medical students to stay or leave the region weighing postgraduation options. Semi-structured interviews were employed with final year medical students. Transcripts were open-coded and analyzed using the theoretical concept of Gemeinschaft/Gesellschaft. Participants were in continuous negotiation between notions of Gemeinschaft and Gesellschaft in their decisions to stay or leave rural Appalachian communities. Students navigated multiple tensions in their decisions to stay or leave, including: (1) geographic isolation versus place identity and (2) community responsibility versus individual opportunity. Utilization of Gemeinschaft/Gesellschaft provides a novel contribution to the literature on decisions to stay or leave as the majority of participants hedged in their decision-making regarding future practice location. These students tended to employ a Gesellschaft rationale to stay and a Gemeinschaft rationale to leave, expressing complicated ideas about community and individual opportunity.