Factors affecting career preferences of medical students at the College of Medicine, Malawi.

BACKGROUND The shortage of doctors in all specialties in Malawi is particularly severe in rural areas. Contributory factors are the low number of students graduating each year, migration of doctors, and the preference of new graduates for practising in urban areas. Attempts to increase the output from Malawi's only medical school are insufficient to meet the country's healthcare needs. METHODS We studied the factors influencing career choices of medical undergraduates of the College of Medicine in Blantyre, Malawi, who were surveyed by means of a self-administered questionnaire (N=205) and individual interviews (N=17). RESULTS Most respondents (89.4%) indicated that they intend to specialise abroad, predominantly to study in 'better institutions' and to get the 'experience' of a different country; 87.0% indicated that they intend to live in Malawi long term. Although, in general, the rural lifestyle was unattractive to medical students, respondents from rural areas and small towns, and whose parents were 'non-professionals', were more likely to intend working in rural areas and small towns, and to settle in Malawi, than students from urban and professional families. CONCLUSIONS The College of Medicine should consider increasing its intake of students with lower socio-economic backgrounds and from rural areas/small towns to increase the number of doctors working in rural areas and settling in Malawi. However, the Ministry of Health may need a multipronged approach to reduce the mismatch between doctors' career expectations and the country's healthcare needs.