Abstract
The aim of this study was to identify the preference of Indonesian medical students to work in rural areas, to enroll in the (PTT; which means 'temporary employment') program, and to identify factors that influence their choice of a preferred future practice area. Under the PTT program, doctors are obliged to work as temporary staff on a contract basis for a certain period in a rural area of Indonesia. The study design was cross-sectional and a total sampling method was used. The subjects were year 4 and 5 medical students from the Faculty of Medicine at Universitas Indonesia and had already been exposed to clinical practice rotations within their education program. Students rated the importance of 21 factors influencing their future workplace preference using a questionnaire with a five-point Likert scale. A total of 310 students (83.3%) responded to the questionnaire. The authors found that 27 out of 310 (8.71%) subjects wanted to work in rural areas, while 128 out of 264 (48.5%) students who chose other than rural areas wanted to enroll in the PTT program. A previous experience of living in rural areas seemed to be the only factor favouring students' choice to have future practice in rural areas (adjusted odds ratio (OR) 3.20, 95% confidence interval (CI) 1.27-8.08, =0.01). Factors that influenced respondents to say they didn't intend to practice rurally were the influence of spouse (adjusted OR 0.38, 95%CI 0.16-0.89, =0.03), and the opportunities for career advancement (adjusted OR 0.28, 95%CI 0.11-0.73, =0.009). The choice of enrollment in the PTT program was positively associated with opportunity for an academic career (adjusted OR 2.39, 95%CI 1.27-4.50, =0.007) and negatively associated with proximity to family/friends (adjusted OR 0.38, 95%CI 0.22-0.65, 0.001). Only 8.7% of the students were interested in rural areas for their future practice location. Multiple factors were associated with students' interest to choose a career in rural areas later, after graduation from medical school.
Highlights
The aim of this study was to identify the preference of Indonesian medical students to work in rural areas, to enroll in the pegawai tidak tetap (PTT; which means 'temporary employment') program, and to identify factors that influence their choice of a preferred future practice area
A total of 310 subjects from 372 year 4 and 5 medical students participated in this study (83.3% response rate)
Of those students who did not want to practice in rural areas for a long period, 48.5% still wanted to devote themselves to rural areas in the short term through the PTT program organized by the government
Summary
The aim of this study was to identify the preference of Indonesian medical students to work in rural areas, to enroll in the pegawai tidak tetap (PTT; which means 'temporary employment') program, and to identify factors that influence their choice of a preferred future practice area. The authors found that 27 out of 310 (8.71%) subjects wanted to work in rural areas, while 128 out of 264 (48.5%) students who chose other than rural areas wanted to enroll in the PTT program. The distribution of physicians in Indonesia is unequal: services are concentrated in metropolitan areas, such as Jakarta. This condition leads to poor health services in rural areas, mainly in primary care services. Considering the interrelated factors in the current health system in Indonesia (ie referral system and continuity of care), lack of PCP may negatively affect the provision of health services in Indonesia[2]
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