Abstract
BackgroundThe World Health Organization (WHO) recommended physician to population ratio is 23:10,000. Kenya has a physician to population ratio of 1.8:10,000 and is among 57 countries listed as having a serious shortage of health workers. Approximately 52 % of physicians work in urban areas, 6 % in rural and 42 % in peri-urban locations. This study explored factors influencing the choice of career specialization and location for practice among final year medical students by gender.MethodsA descriptive cross-sectional study was carried out on final year students in 2013 at the University of Nairobi’s, School of Medicine in Kenya. Sample size was calculated at 156 students for simple random sampling. Data collected using a pre-tested self-administered questionnaire included socio-demographic characteristics of the population, first and second choices for specialization. Outcome variables collected were factors affecting choice of specialty and location for practice. Bivariate analysis by gender was carried out between the listed factors and outcome variables with calculation of odds ratios and chi-square statistics at an alpha level of significance of 0.05. Factors included in a binomial logistic regression model were analysed to score the independent categorical variables affecting choice of specialty and location of practice.ResultsInternal medicine, Surgery, Obstetrics/Gynaecology and Paediatrics accounted for 58.7 % of all choices of specialization. Female students were less likely to select Obs/Gyn (OR 0.41, 95 % CI =0.17-0.99) and Surgery (OR 0.33, 95 % CI = 0.13-0.86) but eight times more likely to select Paediatrics (OR 8.67, 95 % CI = 1.91-39.30). Surgery was primarily selected because of the ‘perceived prestige of the specialty’ (OR 4.3 95 % CI = 1.35-14.1). Paediatrics was selected due to ‘Ease of raising a family’ (OR 4.08 95 % CI = 1.08-15.4). Rural origin increased the odds of practicing in a rural area (OR 2.5, 95 % CI = 1.04-6.04). Training abroad was more likely to result in preference for working abroad (OR 9.27 95 % CI = 2.1-41.9).ConclusionsThe 4 core specialties predominate as career preferences. Females are more likely to select career choices due to ‘ease of raising a family’. Rural origin of students was found to be the most important factor for retention of rural health workforce. This data can be used to design prospective cohort studies in an effort to understand the dynamic influence that governments, educational institutions, work environments, family and friends exert on medical students’ careers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0528-1) contains supplementary material, which is available to authorized users.
Highlights
The World Health Organization (WHO) recommended physician to population ratio is 23:10,000
The results of this study suggest that students with rural origin were more likely to return to practice in rural areas
Rural origin increased the odds of practicing in a rural area
Summary
The World Health Organization (WHO) recommended physician to population ratio is 23:10,000. Kenya has a physician to population ratio of 1.8:10,000 and is among 57 countries listed as having a serious shortage of health workers. The number of health professionals in an area and more importantly their distribution has been shown to have a direct impact on health outcomes [7] This mal-distribution, work force shortage and imbalance in skill-mix exist within poor and rich countries [8, 9]. Multiple factors affect the demand and supply of health care workers in a country. In this study international working experience or training was more likely to result in avoidance of rural practice This may have policy implications on selection of students for medical schools especially where rural–urban maldistribution of doctors exists [17]
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