Do South African medical students of rural origin return to rural practice?

Abstract

Objectives: To investigate the career choices of medical graduates of rural origin in the South African context, and to determine what proportion of rural-origin graduates are currently practising in a rural area.

Design: This is a retrospective descriptive study. Doctors' addresses at the time of graduation were compared with their current addresses in terms of rural/urban classification, and a questionnaire survey was done.

Subjects: Sample A consisted of a cohort of doctors who graduated in 1991 and 1992. Sample B consisted of the 1994-1996 graduates of two medical schools.

Outcome measures: Percentage of rural-origin graduates in rural practice.

Results: In sample A 14.4% were rural-origin students. When comparing addresses, it was found that 38.4% of rural-origin graduates are currently practising in rural areas, compared with 12.4% of urban-origin graduates (p < 0.001). The questionnaire data showed that 45.9% of the rural-origin respondents are in rural practice, compared with 13.3% of the urban-origin respondents (p = 0.001). In sample B, 41.61% of the rural-origin graduates are in rural practice compared with 5.08% of urban-origin graduates (p < 0.001).

Conclusion and recommendations: The findings suggest that the South African situation is similar to that in other countries, with rural-origin medical students more likely to choose rural careers than urban-origin students. Rural-origin graduates are also more likely to choose general practice. It is recommended that the selection criteria of the medical faculties be reviewed with regard to rural origin, and that the career aspirations of applicants to medical school be taken into account in selection, particularly with regard to primary care or general practice.