{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T14:43:04Z","timestamp":1792420984785,"version":"4.5.0"},"reference-count":36,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Rural India Support Trust","award":["FFE\/RIST\/KP\/2025-26\/51125"],"award-info":[{"award-number":["FFE\/RIST\/KP\/2025-26\/51125"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore how three generational cohorts of Indian medical practitioners perceive rural practice and identify the feedback mechanisms driving these shifts across career stages. We frame these shifts as a question of everyday health system resilience: the system\u2019s capacity to sustain rural service delivery under chronic, accumulating stress rather than discrete shocks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Exploratory qualitative study using semi-structured in-depth interviews, by telephone or video across nine Indian states. Forty-four participants formed three groups: senior rural health leaders with 20+ years\u2019 experience (n=12); mid-career doctors in rural or semi-urban practice (n=10); and MBBS (Bachelor of Medicine, Bachelor of Surgery) alumni and interns at career entry (n=22), predominantly first-generation, rural-origin doctors recruited through a national medical scholarship programme. A two-stage systems-informed framework analysis was applied: Stage 1 produced a cross-generational thematic matrix; Stage 2 extended it into a causal loop diagram (CLD). Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight system variables showed a measurable directional trajectory across cohorts: entry motivation, financial expectations, career and postgraduate calculation, mentorship, infrastructure, safety, peer proximity, and attitudes to policy coercion. Rural practice shifted from a non-deliberate calling (Group 1), through pragmatic survival under strain (Group 2), to a conditional, calculated risk dominated by NEET-PG competition, family obligations, and safety (Group 3). Three feedback loops emerged: a reinforcing training-pipeline loop, a broken career-calculations loop, and a reinforcing generational-drift loop.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The shift from calling to calculations is structural, reflecting changes in system conditions rather than any decline in doctors\u2019 professional values. Three leverage points - a) postgraduate examination capital, b) peer co-posting, and c) formalised mentorship, correspond to the adaptive and transformative capacities that build everyday resilience, whereas compulsory bonds represent a failed absorptive response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319261495931","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:23:20Z","timestamp":1792149800000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["From Calling to Calculated Choice: Generational Shifts in Career Perceptions of Rural Practice Among Indian Doctors"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5362-0531","authenticated-orcid":false,"given":"Usha","family":"Manjunath","sequence":"first","affiliation":[{"name":"Institute of Health Management Research (IIHMR) Bangalore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3046-9067","authenticated-orcid":false,"given":"Akash Gajanan","family":"Prabhune","sequence":"additional","affiliation":[{"name":"Institute of Health Management Research (IIHMR) Bangalore"},{"name":"Victoria University Online, Victoria University, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4981-8536","authenticated-orcid":false,"given":"Akshaya Sudha","family":"Chandrasekaran","sequence":"additional","affiliation":[{"name":"Institute of Health Management Research (IIHMR) Bangalore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mittal","family":"Parmar","sequence":"additional","affiliation":[{"name":"Scholarships, Foundation for Excellence India Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/ajr.13121"},{"key":"e_1_3_6_3_2","volume-title":"Rural health in Australia snapshot 2023","author":"National Rural Health Alliance","year":"2023","unstructured":"National Rural Health Alliance. Rural health in Australia snapshot 2023. Deakin ACT: NRHA; 2023. https:\/\/www.ruralhealth.org.au\/wp-content\/uploads\/2024\/04\/NRHA_rural_health_in_Australia_snapshot_2023.pdf, Accessed April 22, 2026."},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp24X737073"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12960-025-00980-x"},{"key":"e_1_3_6_6_2","article-title":"The state of rural primary care in the United States","author":"Commonwealth Fund","year":"2025","unstructured":"Commonwealth Fund. The state of rural primary care in the United States. New York: Commonwealth Fund. 2025. https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2025\/nov\/state-rural-primary-care-united-states, Accessed April 22, 2026.","journal-title":"New York: Commonwealth Fund"},{"key":"e_1_3_6_7_2","volume-title":"Addressing rural health worker shortages","author":"Joint Economic Committee Democrats","year":"2024","unstructured":"Joint Economic Committee Democrats. Addressing rural health worker shortages; 2024. Washington DC: US Senate. https:\/\/www.jec.senate.gov\/public\/index.cfm\/democrats\/2024\/1\/addressing-rural-health-worker-shortages, Accessed April 22, 2026."},{"key":"e_1_3_6_8_2","volume-title":"The New Zealand Medical Workforce in 2024","author":"Medical Council of New Zealand","year":"2024","unstructured":"Medical Council of New Zealand. The New Zealand Medical Workforce in 2024. Wellington: MCNZ; 2024. https:\/\/www.mcnz.org.nz\/assets\/Publications\/Workforce-Survey\/Workforce_Survey_Report_2024.pdf, Accessed April 22, 2026."},{"key":"e_1_3_6_9_2","unstructured":"Royal New Zealand College of General Practitioners. Workforce survey 2024. Wellington: RNZCGP. 2024. https:\/\/www.rnzcgp.org.nz\/documents\/603\/2024_WFS_snapshot_FINAL.pdf Accessed April 22 2026."},{"key":"e_1_3_6_10_2","volume-title":"National Medical Register","author":"National Medical Commission","year":"2024","unstructured":"National Medical Commission. National Medical Register. New Delhi: NMC; 2024. https:\/\/nmr-nmc.abdm.gov.in\/nmr\/v3, Accessed April 22, 2026."},{"key":"e_1_3_6_11_2","unstructured":"Ministry of Health and Family Welfare. Rural Health Statistics. 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