Why do graduates choose to work in a less attractive specialty? A cross-sectional study on the role of personal values and expectations

Abstract

Background: Primary health care (PHC), of which preventive medicine (PM) is a subspecialty, will have to cope with a deficiency of staff in the future, which makes the retention of graduates urgent. This study was conducted in Vietnam, where PM is an undergraduate degree in parallel to medical training. It aims to identify facilitating and hindering factors that impact recruitment and retention of PM graduates in the specialty. Methods: A cross-sectional study enrolled 167 graduates who qualified as PM doctors from a Vietnamese medical school, between 2012 and 2018. Data were collected via an online questionnaire that asked participants about their motivation and continuation in PM, the major life roles that they were playing, and their satisfaction with their job. Multiple regression analyses were used to identify which life roles and motivational factors were related to the decision to take a PM position and to stay in the specialty, as well as how these factors held for subgroups of graduates (men, women, graduates who studied PM as their first or second study choice). Results: Half of the PM graduates actually worked in PM, and only one fourth of them expressed the intention to stay in the field. Three years after qualification, many graduates had not yet decided whether to pursue a career in PM. Satisfaction with opportunities for continuous education was rated as highly motivating for graduates to choose and to stay in PM. Responsibility for taking care of parents motivated male graduates to choose PM, while good citizenship and serving the community was associated with the retention of graduates for whom PM was their first choice. Conclusions: The findings demonstrate the importance of social context and personal factors in developing primary care workforce policy. Providing opportunities for continued education and enhancing the attractiveness of PM as an appropriate specialty to doctors who are more attached to family and the community could be solutions to maintaining the workforce in PM. The implications could be useful for other less popular specialties that also struggle with recruiting and retaining staff.

Attracting and retaining physicians in less attractive specialties: the role of continuing medical education

“…For example, physicians working in rural Kenya and Benin feel more comfortable and confident with their work taking short training courses, with about 20% of them mentioning an increase of interest and work commitment [ 31 ]. This effectiveness of CME on satisfaction and retention of physicians working in LASs is also reported in other countries [ 34 – 39 ]. Considering that training programs for physicians in LASs, including in-service training or continuing education, are often not available [ 40 – 43 ], there is a need for information on how CME can be designed and implemented to increase physicians’ motivation to work in LASs.…”

“…Another demotivating factor is that physicians in LASs have fewer opportunities to participate in continuing medical education (CME) activities, such as classes, seminars, and training, to update their knowledge and extend skills in their field. Indeed, CME is considered an important factor motivating doctors to work in LASs [7,10,34], as it significantly improves satisfaction, learning, performance, and specialist recertification in LASs physicians [30][31][32][33]. For example, physicians working in rural Kenya and Benin feel more comfortable and confident with their work taking short training courses, with about 20% of them mentioning an increase of interest and work commitment [31].…”

Relationship between medical students’ negative perceptions of colleagues’ work–life and burn-out during clerkships: a longitudinal observational cohort study

“…7 It even revealed that responsibility for taking care of parents motivated male graduates at one Vietnamese medical school to choose a medical specialty more attached to family and the community. 64 Or, the female students in our study just too young having no spouses or family responsibilities yet so that their NWLB would not have caused their perceptions to differ from those of male students.…”

“I’m 'just' a community pediatrician” views and challenges of pediatricians working in the community in Israel

“…Community medicine is often perceived as less prestigious, less challenging and less innovative than hospital medicine 1 [ 16 ]. In less prestigious fields of medicine, physicians face lower reputation, higher workload, feelings of professional isolation, limited career development opportunities and high burnout [ 17 , 18 ]. These, in turn, may affect professional identity and make doctors less satisfied and less likely to stay in their position, which leads to health service workforce imbalances and suboptimal health outcomes, especially in primary care areas such as pediatrics [ 16 ].…”