What impedes working in rural areas? A study of aspiring doctors in the National Capital Region, India.

INTRODUCTION The rural health system in India has long been disadvantaged by a shortage of health staff, including doctors. Providing medical students with a rural clinical placement has been suggested as one strategy to overcome this shortage. This study examined the attitudes of and inclination to rural healthcare careers among medical students. METHODS A cross-sectional study was performed on 201 students (147 males and 54 females) from two medical colleges in the National Capital Region (NCR) of India. A pre-tested semi-open-ended questionnaire was used to obtain information about students' socio-demographic characteristics and their views about a rural health career. Students' open-ended responses were collated and coded into broad categories. RESULTS Of the respondents, 160 (79.6%) had a rural background. The current status of rural health services in India was rated as unsatisfactory by 178 students (88.6%). In total 110 (54.7%) indicated an interest in working in a rural area after graduation with 68 (33.8%) willing to set up their practice in a rural area. Students with a rural background were more likely to be willing to practice in a rural area. Those whose parents were highly qualified (postgraduate education or higher) were significantly less likely to practice in a rural area (p=0.004). Potential benefits of working in a rural area included 'health services for the poor/ benefit for the nation', and 'gain of knowledge about rural people and their diseases'. Potential drawbacks included 'lack of infrastructural facilities', 'less salary' and 'low standard of living'. A majority of the students believe the undergraduate medical curriculum needed modification to improve student awareness of rural needs. CONCLUSION The medical students surveyed had a positive view of the importance of rural health care. However, factors such as infrastructure and salary were perceived as potential barriers to a career in rural health. The findings are a starting point to understanding the attitude of medical students towards rural health care and designing specific strategies to overcome the shortage of rural doctors in India.