Rural retention of doctors graduating from the rural medical education project to increase rural doctors in Thailand: a cohort study

Abstract

BackgroundIn Thailand, the inequitable distribution of doctors between rural and urban areas has a major impact on access to care for those living in rural communities. The rural medical education programme ‘Collaborative Project to Increase Rural Doctors (CPIRD)’ was implemented in 1994 with the aim of attracting and retaining rural doctors. This study examined the impact of CPIRD in relation to doctor retention in rural areas and public health service.MethodsBaseline data consisting of age, sex and date of entry to the Ministry of Health (MoH) service was collected from 7,157 doctors graduating between 2000 and 2007. There were 1,093 graduates from the CPIRD track and 6,064 that graduated through normal channels. Follow-up data, consisting of workplace, number of years spent in rural districts and years within the MoH service, were retrieved from June 2000 to July 2011. The Kaplan-Meier method of survival analysis and Cox proportional hazards ratios were used to interpret the data.ResultsFemale subjects slightly outnumbered their male counterparts. Almost half of the normal track (48%) and 33% of the CPIRD doctors eventually left the MoH. The retention rate at rural hospitals was 29% for the CPIRD doctors compared to 18% for those from the normal track. Survival curves indicated a dramatic drop rate after 3 years in service for both groups, but normal track individuals decreased at a faster rate. Multivariate Cox proportional hazards modelling revealed that the normal track doctors had a significantly higher risk of leaving rural areas at about 1.3 times the CPIRD doctors. The predicted median survival time in rural hospitals was 4.2 years for the CPIRD group and 3.4 years for the normal track. The normal track doctors had a significantly higher risk of leaving public service at about 1.5 times the CPIRD doctors.ConclusionsThe project evaluation results showed a positive impact in that CPIRD doctors were more likely to stay longer in rural areas and in public service than their counterparts. However, turnover has been increasing in recent years for both groups. There is a need for the MoH to review and improve upon the project implementation.

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

“…As highlighted in the introduction, research on the retention of dental professionals in remote and rural areas is quite sparse relative to similar research regarding medical and nursing professionals 7–10. Therefore, this study helps fill the knowledge gaps on this subject in the field of dental professionals, and the methodology applied serves as an example for health-system researchers of how to gather and analyze evidence to answer real-life policy-research questions.…”

“…While there is a fair amount of evidence in the fields of medicine and nursing, little is known about whether, or to what extent, the aforementioned aforementioned strategies are still applicable to other health cadres 7–10. Dentists are one of the groups within the health workforce for which there is the least evidence; this is despite the fact that oral diseases are a major health problem worldwide.…”

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran

“…Another factor is education place that most of medical students in Iran are educated in big cities. Educations in remote areas and small towns or rural settings have a positive impact on choosing rural settings by GPs [19,31,37-39]. Even changing education setting for a semester from big cities to smaller towns could have a significant effect on rural and remote areas retention [40].…”

Survival analysis of Rural Clinical School of Western Australia graduates: the long-term work of building a long-term rural medical workforce

“…27 The same time period of loss to rural work was found for newly graduating doctors from Thailand's rural medical education project. 28 Similarly in America, even Rebinowitz's robust data showed a declining survival curve for rural practice amongst both rural programme and no-rural programme graduates 29 One possible explanation for this discrepancy is that our RCS data describe graduates' trajectory from the very beginning of their medical career, including stages before entering and/or fellowing in a vocational college, before urban specialty requirements are imposed. This selection of participants may comprise a period when new graduates are exploring work options, and before they have settled into later career patterns.…”