Career choices and what influences Nepali medical students and young doctors: a cross-sectional study.

Bruce W Hayes,Rabina Shakya

doi:10.1186/1478-4491-11-5

Bruce W Hayes, Rabina Shakya

Open Access

https://doi.org/10.1186/1478-4491-11-5

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Abstract

BackgroundNepal, as a nation with limited resources and a large number of poor people, needs far more well-trained, committed general practitioners. The aim of this study was to understand medical career choices and the factors that influence medical students’ and young doctors’ career choices in Nepal and to understand what would encourage them to work in rural areas as generalists.MethodsThis was a cross-sectional study of 1137 medical students (first and final year) and young doctors (interns and residents) from six medical colleges in Nepal who completed a voluntary questionnaire, with some also participating in structured focus groups – 170 first years, 77 final years and 80 graduates – with an additional 28, 44 and 49 written responses respectively.ResultsWithout selective admissions policies, 41.7% (464/1112) of respondents had a rural background – most significant in Year 1 students, males and in colleges outside of Kathmandu. Of the respondents, 569 (50.9%) had a specialty choice starting medical school – the greatest proportion in Year 1. Medicine (especially cardiology) and surgery (particularly among males) were most significant choices at all stages. Only five participants initially and four during their course chose general practice. There appears no interest in, recognition of, significant exposure to, or role models in general practice.Serving the sick, personal interest and social prestige were the most significant influencing factors – consistent across all groups. Course availability was also a factor. To attract doctors to work in rural areas most respondents affirmed the need for a good salary, infrastructure and facilities, scholarships and career development opportunities.ConclusionsChallenges include raising generalists’ profiles within the medical community, government and patient community; changing undergraduate curricula to include greater exposure to good models of rural generalist practice; and providing incentives and attractions for post-graduate training and service.

Highlights

Nepal, as a nation with limited resources and a large number of poor people, needs far more welltrained, committed general practitioners
Revision of undergraduate and postgraduate curricula to include rural health topics to enhance the competencies of health professionals working in rural areas, and thereby increasing their job satisfaction and retention, is recommended [2,3]
Thistlewaite et al [4] and Henry et al [5] confirmed in their literature reviews that prior rural residence is the strongest predictor of choice of a rural career but extended rural exposure during medical training and role models have a significant impact on choice of rural career

Summary

Introduction

As a nation with limited resources and a large number of poor people, needs far more welltrained, committed general practitioners. Nepal faces a shortage of appropriately trained health care workers including doctors to work outside Kathmandu and the other main centres, despite increasing numbers of medical graduates. In 2009, of the 8,118 doctors working in Nepal, Kathmandu’s doctor density was estimated to be 25 times more than in rural Nepal [1]. This is not limited to Nepal; The World Health Organization (WHO) states “one of their most complex challenges is ensuring people living in rural and remote locations have access to trained health workers” [2]. Thistlewaite et al [4] and Henry et al [5] confirmed in their literature reviews that prior rural residence is the strongest predictor of choice of a rural career but extended rural exposure during medical training and role models have a significant impact on choice of rural career

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