Factors affecting medical students’ interests in working in rural areas in North India—A qualitative inquiry

Abstract

Background and ObjectiveThe shortage of doctors, especially in rural areas, is a major concern in India, which in turn affects the effective delivery of health care services. To support new policies able to address this issue, a study was conducted to determine the discouraging and encouraging factors affecting medical students’ interests towards working in rural areas.MethodsThis cross-sectional, descriptive qualitative study has been conducted in three states of North India. It comprised six focus group discussions, each consisting of 10–20 medical students of six government medical colleges. The verbatim and thematic codes have been transcribed by using a ‘categorical aggregation approach’. The discussions were thematically analyzed.ResultsNinety medical students participated in the study. The discouraging factors were grouped under two broad themes namely unchallenging professional environment (poor accommodation facilities and lack of necessary infrastructure; lack of drug and equipment supplies; inadequate human resource support; lesser travel and research opportunities) and gap between financial rewards and social disadvantages (lower salary and incentives, social isolation, political interference, lack of security). Similarly, the encouraging factors were congregated under three main themes namely willingness to give back to disadvantaged communities (desire to serve poor, underprivileged and home community), broader clinical exposure (preferential admission in post-graduation after working more than 2–3 years in rural areas) and higher status and respect (achieving higher social status).ConclusionsThis qualitative study highlights key factors affecting medical students’ interest to work in rural areas. A substantial similarity was noted between the factors which emerge from the current study and those documented in other countries. These findings will help policymakers and medical educators to design and implement a comprehensive human resource strategy that shall target specific factors to encourage medical students to choose job positions in rural areas.

Socio-economic characteristics and career intentions of the WiSDOM health professional cohort in South Africa

“…Notwithstanding the substantial and growing body of literature on the health workforce, the vast majority of HRH studies consist of case-studies [14, 15] or use cross-sectional study designs [16–20]. Although these cross-sectional studies provide useful insights, they have a number of important limitations: they only include health professionals that have remained in the health system; they do not provide information on dynamic changes over time; and they cannot relate cause (such as a new HRH policy) and their effects (e.g.…”

Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review

“…Likewise, medical students’ decisions about work location were associated with the location of family [ 36 , 40 , 42 ]. It was also uncovered that location of family as one of main reasons of intention to work in rural locations [ 49 , 59 ] Some studies, however, found no association between having extended family in rural locations and intention to work rurally [ 33 , 34 ] e) Type of entry to medical school ‡ Some countries allow different types of entry to medical school, such as direct (5 years of medical course for those completing high school) or non-direct or graduate entry (3 years of medical course for those with some tertiary degree). Some schools also offered regular and international program, in which the international program had a higher tuition fee No difference of rural practice between doctors with paramedical or science tracks [ 26 ] Better preference of rural work was found among those: attending the graduate entry compared to direct entry [ 47 ]; enrolled under the regular program compared to those in international program [ 42 ] f) Other aspects that were found as strong predictors: type of high school, personal characteristics, specialty Type of high school refers to the public (government) or private ownership of the school.…”

“…However, in other studies, associations were not found between rural preference and: housing allowance or support [58,75], access to a vehicle [58] and spouse and child education [34] Overall better living conditions [6,10,11,35,45,65,70,71], housings [76,92], basic infrastructure (i.e., electricity, water, communications connectivity) [52,57,59,88], transportation [57,72,74,76], access to nearest town [41], and children schooling facilities [73], were also important attributes to rural preference. Females regarded housing provision higher than males [58,74] [53,72] One study found that higher satisfaction score to work environment were associated with intention to stay working in rural area [91] Other attributes important to improve intention to work or staying in rural areas were: adequate number of health professional [73,85], relationship with colleagues or seniors [80], lack of drugs, equipment and poor facility infrastructure [40,59,60,73,79,81,88,92,94] Of those studies applying discrete choice experiment methods, 2 studies found that an adequate health facility...…”

“…Being enrolled in a special track, in which the scholarship tied to compulsory service provided for those recruited from rural areas, in addition to being recruited from rural areas and received a rurally enhanced curriculum, was associated with better rural preference [48,49] [50,53], spouse employment [53], access to electricity and water supply [36], transportation [49], were among the key reasons for unwillingness to work rurally There is evidence that preference to work in rural locations is associated with: short travel time to work [91], availability of transportation for official and unofficial use [76], positive perception of living conditions [47], and good educational facilities and connectivity [56]. However, in other studies, associations were not found between rural preference and: housing allowance or support [58,75], access to a vehicle [58] and spouse and child education [34] Overall better living conditions [6,10,11,35,45,65,70,71], housings [76,92], basic infrastructure (i.e., electricity, water, communications connectivity) [52,57,59,88], transportation [57,72,74,76], access to nearest town [41], and children schooling facilities [73], were also important attributes to rural preference. Females regarded housing provision higher than males [58,74] [53,…”

“…Interaction between urban and rural health workers comprising communication or consultation of doctors in rural areas with specialists or others with higher skills in urban areas Limited access to highly skilled colleagues was among explanations discouraging doctors to work in rural areas [70,73] Access to specialists or consultant was mostly considered important for increasing preference to rural work [58,79], though, it was off less importance when compared to increased salary, posting near home province, opportunity to continue to specialization and career promotion [54] d) Career ladders † Career ladder refers to career path that promotes doctor to a higher position, which is generally have better salary and benefit Poor career ladder schemes were one of reasons hindering doctors to work rurally [50,52,57,70,83]. One of Thai government's policy to improve rural recruitment was to provide opportunity for rural doctors to attain a high position, equivalent to that in urban location [31] Creating a clear career ladder is important to improve doctors' preferences to work in rural or remote locations [36,47,59,60,73,79,85,86,88,92,93] The following are examples of career promotion schemes preferred for rural doctor recruitment: associated with higher rural work preferences were: promoted as permanent staff [54,76], possibility to transfer to other more developed areas after certain period of employment [56] e) Professional network † Professional network refers to opportunity to connect and communicate with other peers in rural health service A study found professional isolation was a deterrent to work rurally [52], while the presence of network of rural doctor is believed to improve doctors' willingness to practice rurally [31] A disconnected health services between urban and rural was among the prioritized attributes desirable by doctors for working in rural areas.…”