Abstract
BackgroundNepal is experiencing a public health issue similar to the rest of the world, i.e., the geographical maldistribution of physicians. Although there is some documentation about the reasons physicians elect to leave Nepal to work abroad, very little is known about the salient factors that influence the choice of an urban versus rural practice setting for those physicians who do not migrate. In recent years, around 1000 medical students became doctors within Nepal, but their distribution in rural locations is not adequate. The purpose of this study was to explore what factors influence the choice of urban or rural location for the future clinical practice of Nepalese medical students in the final year of their programMethodsA cross-sectional descriptive study design was used for this study involving Nepalese medical students in their final year of study and currently doing an internship in a medical college. The sample consisted of 393 medical students from four medical colleges in Nepal that were selected randomly. An anonymous self-administered questionnaire was used for data collection. To determine the association with rural location choice for their future practice setting, a comparison was done that involved demographic, socio-economic, and educational factors. Data were entered in EpiData and analyzed by using SPSS version 16.ResultsAmong the 393 respondents, two thirds were male (66.9%) and more than half were below 25 years of age. Almost all (93%) respondents were single and about two thirds (63.4%) were of Brahmin and Chhetri ethnic origin. About two thirds (64.1%) of the respondents were born in a rural setting, and 58.8% and 53.3% had a place of rearing and permanent address in a rural location, respectively. The predictors of future rural location choice for their clinical practice (based on the bivariate analysis) included:Rural (versus urban) place of birth, place of rearing, and permanent addressSource of family income (service, business, and agriculture)Occupation of father (service, business and agriculture)Wealth ranking (higher, middle, and lower wealth rank)Educational factors: location, type of secondary education, and type of higher secondary educationConclusionFor medical students who were soon to complete their studies, demographic and educational factors were found to be significant predictors for a rural location choice, as opposed to socio-economic factors. Our findings indicate that to ensure the rural retention of physicians, the government of Nepal should attract potential medical students from those who were reared and educated in a rural setting.
Highlights
Nepal is experiencing a public health issue similar to the rest of the world, i.e., the geographical maldistribution of physicians
Our findings indicate that to ensure the rural retention of physicians, the government of Nepal should attract potential medical students from those who were reared and educated in a rural setting
Research setting and sampling strategy The sample included (a) Nepalese medical students in their final year of study who were doing an internship in Bachelor of Medicine and Bachelor of Surgery (MBBS) at four randomly selected colleges affiliated with Tribhuvan University and Kathmandu University and (b) recent medical student graduates/ young doctors who were working in different geographical locations and/or preparing to leave for work abroad (N = 25)
Summary
Nepal is experiencing a public health issue similar to the rest of the world, i.e., the geographical maldistribution of physicians. One noted worldwide trend has been the migration of the health care worker, physicians, from medically less served to better served areas This paradoxical flow occurs over a continuum that includes both internal migration (usually from a rural to an urban setting) and external migration (from developing to developed countries), thereby creating a situation of limited availability and utilization of quality rural health care services [1]. This highly uneven distribution between urban and rural areas is rooted in the fact that cities offer workers better income, more opportunities for career progression, better infrastructure, and more social amenities than rural areas [2]. The phenomenon of inadequate numbers of doctors internationally, exacerbated by the large numbers of them in the private sector, in cities and in wealthier countries, has resulted in societal segments who are in dire need of help (e.g., poor, rural, and marginalized individuals and groups) and are underserved [5]
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