Will Graduating Medical Students Prefer to Practise in Rural Communities?

Abstract

Background: The shortage of doctors and their maldistribution between urban and rural areas contribute to inequitable health care delivery. Strategies are being sought by the government and universities to address these challenges. At the Nelson R Mandela School of Medicine of the University of KwaZulu-Natal the admissions policy ensures greater access to rural students and curricular interventions have been introduced to increase an awareness of the plight of vulnerable communities. This study attempted to ascertain the career intentions of final-year medical students and the influence of area of origin and gender in the location of their proposed future practice. Methods: The 2005 final-year cohort was surveyed by means of an anonymous questionnaire. Demographic information, area of origin and career intentions were canvassed. Students of rural origin were identified as those who matriculated from rural schools and lived more than 200 km from the nearest city. The data were analysed descriptively. Results: Female and rural students accounted for 63% and 11% of the sample respectively. Women were less likely than men to practise in rural areas. Thirty-five per cent indicated a preference for a public government service career as opposed to a private medical (26%) career. Slightly more than 13.7% (n = 26) of the cohort wished to pursue practice or postgraduate careers overseas. Nearly 62% (n = 90) of the students in the current cohort received government subsidies for their studies. Conclusions: The increased intake of students from rural origin and curricular attempts to increase social awareness of vulnerable rural communities are inadequate to alter the perceptions of medical graduates towards rural practice. While government initiatives and medical schools are starting to work together to service rural communities, alternative strategies need to be explored to entice physicians to rural practice.