Why You Can’t Find a Good Doctor in Your Village – The Urban-Rural Health Divide in Georgia
Written by Professor Giorgi Pkhakadze exclusively for www.sheniekimi.ge
Introduction: A Critical Gap in Georgia’s Healthcare
One of the most persistent public health inequalities in Georgia is the gap between urban and rural access to qualified healthcare professionals. Despite improvements in infrastructure and hospital accreditation efforts, many rural regions still struggle to retain skilled doctors. A recent policy analysis, Strengthening Health Workforce in Georgia (Aladashvili et al., 2025), confirms that geographic imbalances in physician distribution are one of the central barriers to equitable care in the country. Read our summary of the study’s findings
This article explores the root causes, consequences, and potential solutions to Georgia’s urban-rural healthcare divide. It is based on national data, academic research, and the groundbreaking recommendations from the 2025 workforce planning study.
The Numbers: Where Are the Doctors?
According to the State Audit Service and National Statistics Office of Georgia, over two-thirds of all licensed physicians practice in Tbilisi — a city that is home to only about one-third of the population. In contrast, entire regions such as Racha-Lechkhumi or Kakheti have only a handful of practicing specialists, and many mountain villages are completely underserved.
The 2025 study by Aladashvili et al. revealed that incentives for rural practice have largely failed. Despite government funding for rural physician programs, most allocated budgets remain unused due to lack of interest or systemic barriers. (DOI: 10.1002/hpm.3922)
To understand how nursing shortages mirror this issue, see our article on Georgia’s nursing workforce crisis.
Why Doctors Avoid Rural Areas
There are many interrelated reasons why doctors avoid working in rural settings:
- Low wages: Salaries in rural areas are often lower than those in urban hospitals, even though the workload can be higher.
- Lack of infrastructure: Many clinics lack basic sanitation, consistent electricity, or internet connectivity.
- Professional isolation: Doctors in remote areas have few opportunities for continuing medical education (CME) or specialist consultation.
- Limited services for families: Schools, housing, and safety for physicians’ families are often cited as reasons to stay in cities.
This has created a cycle of neglect. Without structural incentives or system-wide reform, rural communities are left behind.
Explore how these conditions affect other healthcare workers in Georgia’s rural workforce breakdown.
How This Affects Patients
The shortage of rural doctors means patients must travel long distances to receive care — often delaying treatment or skipping it entirely. In many cases:
- Chronic diseases go unmanaged
- Maternal and child health suffer
- Emergency care is delayed, leading to preventable deaths
These disparities are well-documented in Georgia’s Health System Barometer reports and have been repeatedly flagged by the Public Defender’s Office.
For example, a 2023 government assessment found that fewer than 15% of mountain villages had year-round access to a general practitioner or pediatrician.
Find more on how patient health is impacted by limited access in hospital care quality in Georgia.
Telemedicine: A Missed Opportunity
While digital health solutions are widely available in many countries, Georgia has yet to fully implement telemedicine as a strategic tool for rural care. Some pilot projects exist, but no national telehealth framework has been integrated into public healthcare.
This is despite WHO and EU recommendations to scale up digital platforms in areas where physical infrastructure is lacking. (WHO Health Workforce Strategy)
Learn more about digital care innovations in modernizing rural health.
The Role of Medical Education and Workforce Planning
Georgia’s medical education sector produces over 1,000 new MD graduates each year. However, there is no structured system to guide their placement or support career paths in underserved regions.
The 2025 Aladashvili et al. study recommends the creation of a centralized workforce planning body, tasked with:
- Mapping population health needs
- Creating rural training pathways
- Offering meaningful financial and academic incentives
Without such a system, rural placements will continue to be seen as career dead-ends rather than national priorities.
To explore education gaps further, see nursing education reform in Georgia.
What Can Be Done: Solutions Moving Forward
- Incentives That Work: Offer higher pay, housing, and continuing education support to doctors who commit to rural posts for 3–5 years.
- Mandatory Rural Service: Like many countries, Georgia could introduce 1–2 years of rural practice as a requirement for licensing or residency.
- Rural Residency Tracks: Create dedicated training programs based in regional hospitals, with rotations in mountain clinics.
- Telemedicine Integration: Implement a national telehealth framework to support remote diagnosis, follow-ups, and CME.
- Health Workforce Governance Reform: Establish an independent planning authority, as recommended by the 2025 workforce study.
Expert Commentary
“Access to healthcare is a fundamental right, not a privilege of geography. If a child in Tbilisi can see a doctor within hours, but a child in Svaneti must wait days or travel hundreds of kilometers, the system is failing. Georgia must close this gap.”
– Professor Giorgi Pkhakadze
References:
Aladashvili G, Kirvalidze M, Tskitishvili A, Chelidze N, Tvildiani N, Pkhakadze G, Bossert TJ, Lunze K, Nadareishvili I. Strengthening health workforce in Georgia: Identifying gaps and integrating evidence-based strategic planning. Int J Health Plann Mgmt. 2025. https://doi.org/10.1002/hpm.3922
World Health Organization. Global Strategy on Human Resources for Health: Workforce 2030 [Internet]. Geneva: WHO; 2016. Available from: https://apps.who.int/iris/handle/10665/250368
State Audit Office of Georgia. Audit of rural healthcare and physician distribution [Internet]. Tbilisi: Government of Georgia; 2023.
National Statistics Office of Georgia. Regional Healthcare Profiles 2023 [Internet]. https://www.geostat.ge
Public Defender of Georgia. Accessibility of rural primary care services: Special Report 2023 [Internet]. https://ombudsman.ge
