Rural 'persisters' vs. 'switchers': the interaction of background and programme

Abstract

Introduction/background: Shortages of rural doctors are a threat to health care delivery. Aim/objectives: To compare factors associated with a rural career choice at both entry and exit from medical school (‘persisters’), with ‘switchers’ who had an initial rural choice but urban at exit. Methods Prospective study conducted by the NZ MSOD project group. Survey data were collected from students from both NZ schools each year from 2006-2016. Results: Linked entry and exit data were obtained for 1114 students. Compared with ‘switchers’ (N=135, 12%), rural ‘persisters’ (N=238, 21%) were more likely to have a rural background (P < 0.0001); be female, a member of a Rural Club, identify with ethnicities other than NZ European (all P < 0.01); or have GP career intentions (P< 0.05). Significant influencing factors for rural ‘persisters’ compared with ‘switchers’ were: work culture, medical school experiences, self-appraisal of own skills and domestic circumstances. Influencing factors for ‘switchers’ compared with ’persisters’ were research and teaching opportunities, costs of medical school and vocational training, financial prospects, parents, and years of training. Discussion The two groups differed in significant ways. Some factors were demographic (e.g. rural background, gender, domestic circumstances), and some related to the nature of work (e.g. work culture, financial prospects). New findings point to ways medical schools may help sustain the rural workforce, including provision of rurally-conducive experiences for certain student groups, and on building academic capacity in rural areas. Conclusions: While rural background is the most important predictor of a persistent rural career choice, it is possible to identify other factors which impact upon this choice.