Attitudes toward working in rural areas of Thai medical, dental and pharmacy new graduates in 2012: a cross-sectional survey

Abstract

Background: Inequity in health workforce distribution has been a national concern of the Thai health service for decades. The government has launched various policies to increase the distribution of health workforces to rural areas. However, little is known regarding the attitudes of health workers and the factors influencing their decision to work in rural areas. This study aimed to explore the current attitudes of new medical, dental and pharmacy graduates as well as determine the linkage between their characteristics and the preference for working in rural areas. Methods: A cross-sectional survey was conducted, using self-administered questionnaires, with a total of 1,225 medical, dental and pharmacy graduates. They were participants of the meeting arranged by the Ministry of Public Health (MOPH) on 1-2 April 2012. Descriptive statistics using mean and percentage, and inferential statistics using logistic regression with marginal effects, were applied for data analysis. Results: There were 754 doctors (44.4%), 203 dentists (42.6%) and 268 pharmacists (83.8%) enrolled in the survey. Graduates from all professions had positive views towards working in rural areas. Approximately 22% of doctors, 31% of dentists and 52% of pharmacists selected 'close proximity to hometown' as the most important reason for workplace selection. The multivariable analysis showed a variation in attributes associated with the tendency to work in rural areas across professions. In case of doctors, special track graduates had a 10% higher tendency to prefer rural work than those recruited through the national entrance examination. Conclusions: The majority of graduates chose to work in community hospitals, and attitudes towards rural work were quite positive. In-depth analysis found that factors influencing their choice varied between professions. Special track recruitment positively influenced the selection of rural workplaces among new doctors attending the MOPH annual meeting for workplace selection. This policy innovation should be applied to dentists and pharmacists as well. However, implementing a single policy without supporting strategies, or failing to consider different characteristics between professions, might not be effective. Future study of attitudes and factors contributing to the selection of, and retention in, rural service of both new graduates and in-service professionals was recommended.

Factors associated with the choice of public health service among nursing students in Thailand

“…Rural upbringing and entering the nursing education program by local recruitment were found to be associated with a more positive attitude toward rural areas in this study, and that finding is similar to studies with newly graduated doctors in Thailand and in other low-middle income countries (LMICs) [8, 9]. These studies found that students admitted to medical school through a special quota for rural background students preferred to work in community hospitals in rural areas, and students who have spent a significant period of time in rural settings were more likely to practice in their home country and in rural areas.…”

Rural placement experiences in dental education and the impact on professional intentions and employment outcomes—A systematic review

“…Six of the eleven articles were from Australia, two from South Africa and one from the United States, India and Thailand …”

The impact of rural-exposure strategies on the intention of dental students and dental graduates to practice in rural areas: a systematic review and meta-analysis

“…Only two studies were conducted in middle-income countries: South Africa and Thailand 33,34. Three articles explored the influence of rural origins of dental students/graduates,32–34 while the other four articles investigated the impact of special didactic programs or rural placements after graduation 28–31. It should be noted that the definition of “rural” varied across studies.…”

“…It should be noted that the definition of “rural” varied across studies. For instance, McMillan and Barrie defined “rural” in South Africa as any administrative area that was smaller than a town or city,33 whereas Thammatacharee et al considered the term “rural” to refer to all districts, other than provincial capitals, in all Thai provinces outside Greater Bangkok 34. All the selected articles demonstrated some degree of bias, as they were conducted in uncontrolled settings where randomization was not feasible.…”

“…It should be remembered that only studies published in English were considered for selection. Among the seven selected articles, there was only one study, Thammatacharee et al,34 that was conducted in a country where English is not the official language, and articles from some regions, ie, Europe and Africa, were still missing. Therefore, it is quite likely that language bias exists in the review.…”