Rural retention of new medical graduates from the Collaborative Project to Increase Production of Rural Doctors (CPIRD): a 12-year retrospective study.

Abstract

Physician scarcity in rural areas is a major obstacle to healthcare access, leading to health inequity worldwide. In Thailand, a special recruitment program of medical education [Collaborative Project to Increase Production of Rural Doctors (CPIRD)] was initiated with four different medical training tracks. No previous research has examined the rural retention of new medical graduates across the CPIRD tracks, compared with those receiving conventional medical education (Normal track). This study examines the public retention of rural physicians from different tracks of entry. A retrospective study was conducted in new medical graduates who entered Ministry of Public Health (MoPH) hospitals from January 2003 to October 2014, and followed up until June 2015, using administrative data from the Personnel Administration Division, MoPH. The CPIRD registry database was used to identify physicians' tracks of entry. Survival analyses and multiple logistic regression analyses were applied to compare the annual retention and the probability of 3-year retention of rural physicians. Results clearly demonstrated a high rural retention of CPIRD medical graduates, compared with their Normal track peers, regarding both lower annual resignation (HR 0.456, P < 0.001) and higher 3-year retention (OR 2.441, CI: 2.192, 2.719). Some variations of rural retention were revealed across the different CPIRD tracks. Evidence from this study can be used as part of the information to reshape the physician production policy to reduce health inequity in rural areas.