Adapting to scarcity: plasticity in rural healthcare practice

Abstract Rural healthcare practitioners face persistent challenges such as limited staffing, geographic isolation, and broad scopes of responsibility. These conditions require constant adaptation to ensure care delivery. This study introduces the concept of plasticity, adapted from sociobiology; to examine how rural healthcare teams collectively navigate scarcity through flexible role and task shifting. Drawing on constructivist grounded theory, we conducted 19 interviews with nurses and physicians in emergency departments in two rural communities in Ontario, Canada, to explore how plasticity functions in rural healthcare teams. The analysis identified two variations of plasticity: acute (short-term, high-stakes task switching or role expansion) and chronic (long-term role expansion), alongside four interrelated dimensions that characterize this phenomenon in rural settings. While acute plasticity was often empowering, chronic plasticity, exacerbated by the COVID-19 pandemic, contributed to cumulative stress, burnout, and professional demoralization. Our analysis illustrates that plasticity is both a strength and vulnerability in rural healthcare work, sustained through informal learning and relational responsibility to community, yet largely unsupported by formal institutional structures.