Career choices and what influences Nepali medical students and young doctors: a cross-sectional study

Abstract

BackgroundNepal, as a nation with limited resources and a large number of poor people, needs far more well-trained, committed general practitioners. The aim of this study was to understand medical career choices and the factors that influence medical students’ and young doctors’ career choices in Nepal and to understand what would encourage them to work in rural areas as generalists.MethodsThis was a cross-sectional study of 1137 medical students (first and final year) and young doctors (interns and residents) from six medical colleges in Nepal who completed a voluntary questionnaire, with some also participating in structured focus groups – 170 first years, 77 final years and 80 graduates – with an additional 28, 44 and 49 written responses respectively.ResultsWithout selective admissions policies, 41.7% (464/1112) of respondents had a rural background – most significant in Year 1 students, males and in colleges outside of Kathmandu. Of the respondents, 569 (50.9%) had a specialty choice starting medical school – the greatest proportion in Year 1. Medicine (especially cardiology) and surgery (particularly among males) were most significant choices at all stages. Only five participants initially and four during their course chose general practice. There appears no interest in, recognition of, significant exposure to, or role models in general practice.Serving the sick, personal interest and social prestige were the most significant influencing factors – consistent across all groups. Course availability was also a factor. To attract doctors to work in rural areas most respondents affirmed the need for a good salary, infrastructure and facilities, scholarships and career development opportunities.ConclusionsChallenges include raising generalists’ profiles within the medical community, government and patient community; changing undergraduate curricula to include greater exposure to good models of rural generalist practice; and providing incentives and attractions for post-graduate training and service.

Why not nursing? A systematic review of factors influencing career choice among healthcare students

“…). This is also evident in three different studies in which medical students reported financial remuneration had little or no influence on their career choice (Crossley & Mubarik ; Hayes & Shakya ; Saad et al. ).…”

“…). Such altruistic characteristics were also found among medical and pharmacy students who cited ‘serving the sick’ or ‘helping others’ as significant motivators in their career choice (Crossley & Mubarik ; Hayes & Shakya ; Keshishian ; McHarg et al. ; Saad et al.…”

“…() also found that ‘respect and honour’ had a moderate or low influence on medical students' career choice. However, in a quantitative study, Nepalese medical students rated social prestige as 4.15 on a 5‐point Likert scale, making it the third most influential factor in their career choice (Hayes & Shakya ). The same phenomenon appears in nursing literature.…”

“…). However, a study among medical students in Nepal found that family pressure or having a doctor in the family was rated highly as the two factors that influenced their career choice (Hayes & Shakya ). In addition, a qualitative study (McHarg et al.…”

Motivational Profiles of Medical Students of Nepalese Army Institute of Health Sciences

“…This finding is slightly different to the finding study done in Madhya pradesh in India by Diwan et al 14 where service motive accounted for 20%, while personal ambition and parental desire accounted for 23% each. Another study done in Nepal by Bruce et al 15 found that career choices of medical students was determined by the personal interest, social prestige and passion to serve the sick.…”