Abstract
BackgroundAttracting and recruiting health workers to work in rural areas is still a great challenge in China. The rural-oriented tuition-waived medical education (RTME) programme has been initiated and implemented in China since 2010. This study aimed to examine the attitudes of rural-oriented tuition-waived medical students (RTMSs) in Shaanxi towards working in rural areas and the related influencing factors.MethodsA cross-sectional survey was conducted in 2015 among 232 RTMSs in two medical universities from the first group of students enrolled in the RTME programme in Shaanxi. Descriptive and analytical statistics were used for the data analyses.ResultsOf the 230 valid responses, 92.6% expressed their intentions of breaking the contract for working in rural township hospitals for 6 years after their graduation under the RTME programme. After the contract expired, only 1.3% intended to remain in the rural areas, 66.5% had no intention of remaining, and 32.2% were unsure. The factors related to a positive attitude among the RTMSs towards working in rural areas (no intention of breaking the contract) included being female, having a mother educated at the level of primary school or below, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the policy. The factors related to a positive attitude of the RTMSs towards remaining in rural areas included being female, having a rural origin, having no regular family monthly income, having a father whose occupation was farmer, having a mother educated at the level of postsecondary or above, having the RTMSs be the final arbiter of the policy choice, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the educational scheme.ConclusionsRelated policy makers and health workforce managers may benefit from the findings of this study. Appropriate strategies should be implemented to stimulate the RTMSs’ intrinsic motivation and improve their willingness to work in rural areas and to better achieve the objectives of RTME policy. Meanwhile, measures to increase the retention of RTMSs should also be advanced.
Highlights
Attracting and recruiting health workers to work in rural areas is still a great challenge in China
Descriptive statistics Among the 262 Rural-oriented Tuition-waived Medical Student (RTMS) enrolled in the first group of the Shaanxi rural-oriented tuition-waived medical education (RTME) programme, 232 RTMSs were willing to participate in the investigation and completed the questionnaires
Among the 230 RTMSs, 66.5% were female, 33. 5% were male. 82.2% were from rural areas, and 17.8% were from urban areas
Summary
This study aimed to examine the attitudes of rural-oriented tuition-waived medical students (RTMSs) in Shaanxi towards working in rural areas and the related influencing factors. In 2005, the doctor density in urban areas was more than twice that in rural areas (2.1 per 1000 people vs 1.0 per 1000 people), and the nurse density showed a more than three-fold difference (1.7 per 1000 people vs 0.5 per 1000 people) [5]. The doctor density and nurse density were 3.00 and 3.29 per 1000 people in urban areas and 1.33 and 0.98 per 1000 people in rural areas, respectively. The health worker density was 7.90 per 1000 people in urban areas, which is more than twice that in rural areas (3.19 per 1000 people) in 2011. The inadequacy of health workers with a suitable skill set in rural hospitals has been a major impediment to the implementation and achievement of the policy goals of China’s healthcare reform [7,8,9]
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