Perceived incentives and willingness of university medical students toward working in rural primary healthcare

Abstract

Background Primary healthcare (PHC) is vital for providing more equitable, accessible and affordable healthcare to the population. However, there is a general lacking and disparity of distribution of PHC workforce, especially for rural areas in China as it is very hard to attract and retain high quality medical students to rural PHC. This study was to investigate the willingness of university medical students toward working in rural PHC and their perceived incentives and compare that between medical programmes. Methods An online questionnaire survey was conducted in a leading medical university of Western China in 2017. All second-year Preventive Medicine (MBP, 5 years programme) and third-year Doctorate of Medicine (MD, 8 years programme) students participated. The willingness and perceived incentives toward working in rural PHC were analysed and compared between students of the two programmes. Results A total of 201 students, including 115 MBP and 86 MD students, participated in the study. The overall willingness rate toward working in rural PHC was 16%. More MBP (23%) than MD students (7%) expressed willingness without mention of incentives (p<0.05). The most preferred incentives were adequate remuneration (62%), non-inferior working and living conditions to urban area (58%), limited service years (56%) and privilege to postgraduate education and promotion (55%), though 13% expressed willingness under no circumstances. More MBP than MD students preferred to postgraduate education and promotion (65% vs. 43%, p<0.05) and limited service years (63% vs. 56%, p<0.05), but similar in other incentives (p>0.05). The willingness rate increased from 2%~5%, 9%~14%, 27%~25%, to 81% with single-, two-, three-, four- incentives as mentioned above, and similar between students of the two programmes. Conclusions The willingness of university medical students to work in rural PHC was low. However, more MBP students show willingness than MD students. Multiple incentives including adequate remuneration, opportunities of postgraduate education and promotion, proper working and living conditions and limited service years may be much more effective than any single incentive to attract university medical students especially MBP students to rural PHC service. Further investigation of appropriate incentives in details and interventional studies are warranted to inform relevant policy making.