Career plans of final-year medical students in South Africa

Abstract

There is strong international evidence that students of rural origin, and those who intend to practise rural medicine, are more likely to practise in rural settings after graduation.2 The purpose of this study was to survey final-year medical students about their career plans and the influences on those plans, to ascertain implications for the future training of doctors in South Africa. MethodsFinal-year students at all 8 South African medical schools were asked to complete anonymous self-administered questionnaires during 2007 and 2008. Their geographical origin was defined as where they reportedly grew up. ResultsQuestionnaires were completed by 876 (67%) of the 1 306 students surveyed. Sixty per cent were women, the mean age was 24.7 years (SD 3.3 years), and 92% (N=797) were South African citizens. Of the 846 respondents who indicated their place of origin, 50% had grown up in a city, 30% in small towns, and 20% in rural areas.The majority (84%) planned to remain in the medical field as a career. Forty-one per cent (47% women v. 33% men; p<0.0001) of 849 respondents were not inclined to work overtime during most of their careers. Ten per cent planned to work part-time only, and a third (34% women v. 28% men; p=0.1) planned to take a few years' break (excluding maternity leave) from their careers.More than half (55%) of the 743 students of South African nationality planned to work abroad, either for a year or two (73%) or more (20%). The remaining 7% intended to relocate permanently. Between 47% (of 876 students) and 59% (of 700 who responded to the question) planned to work for a time in rural areas after specialising. Twice as many planned to work for most of their careers in the private rather than the public sector (28 -41% v. 14 -19%; p<0.0001).Those of rural or small-town origin (N=350) were less likely than those of city origin (N=376) to want to work abroad (p<0.001), were more likely to want to work in rural areas (p<0.0001), and were less likely to want to spend most of their career in the private sector (p<0.05). Among respondents planning to work abroad, those of non-urban origin were more likely to work there short-term than those of urban origin (p<0.001).Although only 47% of respondents had made a definite career choice, 93% nevertheless indicated their first choice of specialty. Internal medicine (including sub-specialties) was the leading choice overall (22%) and among women (21%). Surgery (including sub-specialties) was second overall (20%), the top choice of men, and the second-ranked choice of women (26% v. 16%; p<0.001). Paediatrics was the third-placed choice overall (12%). It was significantly more popular among women than men (16% v. 6%; p<0.001), as was obstetrics and gynaecology (11% v. 6%; p<0.05).

Physician Migration in the Global South between Cuba and South Africa

“…In the last 30 years, however, attention has shifted to the public health impacts of physician migration, and broader concerns with the “brain drain” of skilled migration, from the global south (Wright et al., ). The unsustainable movement of physicians from the global south is recognized as a major challenge: the WHO () estimates physician expatriation rates of over 50% from Tanzania and Sierra Leone and over 60 per cent for Mozambique and Angola, while survey data indicates that 55 per cent of South African medical graduates plan to emigrate (De Vries, ).…”

Slaves of the state - medical internship and community service in South Africa

“…21 This argument is fallacious because financial incentives alone are insufficient to motivate and retain all levels of health practitioners in rural areas, 22 and it is physically impossible for males or females to function optimally without sleep, no matter how much they are paid to do so.…”

The Brain Drain Potential of Students in the African Health and Nonhealth Sectors

“…Concerns about the long-term impact of the migration of health professionals from developing countries have recently led to a focus on the next generation, both in Africa [8][9][10][11][12][13][14] and elsewhere [15][16][17][18][19][20]. Many countries invest substantial financial resources in the training of physicians and nurses.…”