Study of Working Experience in Remote Rural Areas after Medical Graduation

Abstract

Background Posting of doctors in remote rural areas has always been a priority for Government; however data are scarce in the country about experience of doctors of working in remote areas after medical graduation.Objective A questionnaire survey of doctors was planned to analyze their experience of working after graduation in remote rural areas in various parts of the country.Method The cross-sectional survey was done by convenience sampling method. A one-page questionnaire with one partially closed-end and five open-end type questions was distributed to the doctors who had worked in remote rural areas after graduation under various governments’ postings.Result Two-third of participants had their home in urban areas and 89.8% had stayed for 1 to 5 years. About half of the participants had difficulty in getting the posting in the remote areas of their choice. Most participants indicated provision of opportunities for Residential (postgraduate) Training as their reasons of going to remote areas as well as their suggestions to encourage young graduates to go there. Similarly most also suggested appropriate career, salary and incentives to encourage doctors to go to work in remote areas. About 85% of participants pointed out the major problem faced while posted in remote areas as difficulty in handling varied situations with no guidance or seniors available around.Conclusion The notable points indicated by the participants are centered on the opportunity for Residential Training and difficulties faced without such training. Residential Training is a priority to be considered while planning the health policy for optimum health care of people.Kathmandu University Medical Journal Vol.12(2) 2014: 121-125

Facilitation of free residential training inside the country – The fundamental health service responsibility of the Government and its regulatory body

“…1 In a study of experience of doctors working after MBBS (Bachelor of Medicine and Bachelor of Surgery) in various parts of the country, about 85% of the participants indicated the major problem faced while posted in remote areas as difficulty in handling varied situations with no guidance or seniors available around. 2 This is consistent with the observation that doctors with just MBBS often have difficulties in conducting complicated deliveries and in performing required surgeries and procedures. 3 The insufficiency of MBBS education alone to give enough confidence to medical students or doctors to practice independently was indicated by various publications in the country.…”

“…3 The insufficiency of MBBS education alone to give enough confidence to medical students or doctors to practice independently was indicated by various publications in the country. 2,4,5 To teach anatomy in cadavers also, further three years of training is made mandatory by the regulatory bodies for doctors with MBBS who have already passed anatomy earlier during their study. The responsibility of the Government and its agencies to provide optimal Peripheral Health Service to people may not be achieved by just posting the MBBS doctors without Residential Training.…”

“…The responsibility of the Government and its agencies to provide optimal Peripheral Health Service to people may not be achieved by just posting the MBBS doctors without Residential Training. 2 Ensuring access to the skilled health workers is a necessary condition for realizing the human rights to health. 6 While city hospitals regularly conduct lifesaving caesarian sections, less than 20% of district hospitals did even a few years back due to the lack of Specialists in GP, called here MDGPs i.e.…”

“…The dire need of Residential Training has also been indicated by various reports in the country. 2,4,5,44 In a study, about 70% of the senior medical students even pointed out they need to leave Nepal to get the necessary training, as there is not much Residential Trainings available in the country.…”

“…The importance of appropriate management of postings and career of Government doctors have been emphasized by many studies and publications in the Bhattarai Facilitation of free residential training inside the country -The fundamental health service responsibility of the Government... country. 2,9,12,13,17,96 For promotions and appointment by the Public Service Commission, the required minimum duration for the level of posting after the Residential Training in the concerned Specialty should be considered (Table 2), rather than just the duration after MBBS or other General Specialist Training or initial appointment in the Government job. In view of the increasing urbanization and transport, the issue of working in remote or rural areas or outside the capital for some time may not be applicable to the promotion of the non-GP specialists who need to work in well equipped Public Hospitals with a team of other specialists in the urban or semi-urban areas (Figure 2).…”