Rural physician recruitment program in Thailand: factors associated with medical student enrollment and post-graduation intentions

Abstract

Objectives: Thailand’s Collaborative Project to Increase Production of Rural Doctor (CPIRD) recruits students with a rural background and provides clinical year training in provincial teaching hospitals. We studied the main reasons for students attending this rural recruitment project and their intention to work in rural areas. Methods: In 2018, 2,870 4th–6th year medical students from 34 teaching hospitals under the CPIRD were sent a questionnaire surveying the following factors: their gender; year of study; size of the teaching hospital in which they were training; a domicile of origin and the province where they attended a high school; parent’s occupation; family income and main reasons for choosing to attend the CPIRD rural medical schools, as well as their attitudes towards rural job placement. Factors associated with a student's intention to work in rural areas were also examined, using multiple logistic regression. Results: 1,349 (47%) students responded. 809 (60%) were female, 914 (68%) had adequate family income, 519 (38%) had a domicile of origin in rural areas, 247 (18%) had either a mother or father being health professionals. The top three main reasons for choosing to attend the rural medical schools were: intention to return to work in their hometown
(32%); student recruitment being less competitive (18.5%); and pre-specified job placement in their home districts (15%). Medical students who had a domicile of origin in rural areas, CPIRD recruitment track, and trained in medium and small-sized teaching hospitals had higher intention to work in rural areas, with Odds ratio of 1.51 (95% confidence interval (CI) 1.06-2.15), 4.39 (95%CI 3.02-6.39), 1.54 (95% CI 1.09-2.17) and
1.74 (95% CI 1.14-2.65), respectively. 1,283 (95%) medical students had a favorable attitude towards rural placement after their graduation. Conclusion: Students´ rural background and training in provincial teaching hospitals may enhance their intention to start and remain working in rural healthcare services.