A shortage of physicians and a rural-urban imbalance in the distribution of health professionals are widespread problems nowadays. Medical graduates are considered as a next generation of doctors, but many of them do not choose medical career after graduation, particularly in the regions with low population density and severe climate. This study was conducted to find possible options to prevent further shortage of primary care physicians in remote areas based on the medical graduates’ opinions, and search the factors that influence their decision to work in practical medicine positively. A cross-sectional study provided full coverage of 720 final year medical students using an anonymous questionnaire in Krasnoyarsk, Russia. Data were analyzed using SPSS Version 22 by the following methods: descriptive statistics, decision trees analysis, and χ2-test. Most of the graduates reported their intension to work in practical medicine after graduation.Less than half of the participants considered an opportunity to work in rural hospitals. The main motivating factors to work there were increase in salary, better working conditions and hospital equipment, and free housing. Students who more inclined to work in rural hospitals mostly came from rural areas, live in dormitory or rental housing, and have an employer-sponsored type of education. An appropriate comprehensive admission process to medical schools, including personality tests and adequate government support for medical university applicants, as well as offers of special conditions of work for young specialists in rural hospitals, could be significant steps to improve the shortage of doctors in remote areas.

Background Changes in technologies and standards of life leads to the fact that each generation is very different from the previous one. Modification of generations affects the quality and the development of medicine. Current medical students are our future doctors. And changes in health care will be made by them soon. So, their views will influence the development of health care system in the future. Therefore, it is important for us to understand how today's graduates see their future work and what is important for them. Methods The opinions of 720 final year medical students were investigated using an anonymous questionnaire in Krasnoyarsk, Russia. Data were analyzed using SPSS 22 program by the following methods (p < 0.05): descriptive statistics, decision trees analysis, χ2-test. Results Medicine have to change rapidly in accordance with the demands of new generations. Only in such case, current graduates of medical schools would like to work in practice medicine in the future. In this work, factors that are important for the work of modern students were investigated. Such posers were examined: the opportunities to work in rural areas and the basis for such decisions, the choice of future doctors' specialty, the young doctors' self-confidence and how much time they need experienced doctors' support as mentors. To avoid further staff shortages, we have to take into account the needs and priorities of today's graduates. Conclusions Practically all of the graduates are not ready to work alone immediately after medical school graduation - 97.0% of them report that they need a mentor. In addition, the majority of them prefer to work with mentor for a year or more (80.5%). Practically half of the students are ready to work in rural areas (49.5%); the most important factors that influence their decision are salary, free housing and clinic's equipment (important for 53.4%, 35.9% and 26.5% of the graduates, respectively). Key messages The majority of the graduates are not ready to work alone immediately after medical school graduation and need a mentor for a year or more. Increased salary, free housing and good clinic’s equipment may attract the medical graduates to work in rural areas.

Background Search for possible improvements in outpatient clinic services is a key task for health care professionals worldwide. It is important to consider the satisfaction of the main participants in primary care: patients and doctors. If patients unsatisfied with primary care will not seek help again, this will reduce their life quality and life expectancy. Unsatisfied doctors will work not efficiently nor for a long time. The work is devoted to the search for possible factors, which change may affect the improvement of the situation in clinics in terms of both doctors and patients. Methods The opinions of 1672 patients of Krasnoyarsk outpatient clinics were investigated with the usage of semi-structured interviews. The opinions of 283 physicians of the city were collected using an anonymous questionnaire. Data were analyzed using SPSS 22 by the following methods (p < 0.05): descriptive statistics, U test, χ2-test. Results Coherence of doctors' and patients' opinions investigated in different ways such as primary care satisfaction, desirable main changes, optimal time, duration and structure of appointment, physician's mission, the possibilities of additional medical remote consultations and difficulties in doctors' access. At some points, the answers were consistent; at some, a compromise or new ways of the solutions were required. Conclusions Almost 61% of the doctors prefer morning work time (8-12 am) and 15.5% prefer work in the evenings (18-20 pm) while only 38.1% of patients can visit a doctor in the morning time and 39.5% in the evening. The main changes to be made according to the general opinion of doctors and patients is a reduction of a waiting time of doctors' appointment (38.1% and 38.5% respectively) and the creation of an electronic queue (26.5% and 30.5% respectively). Remote consultation service have to be organized for patients: phone service is more appropriate as for the doctors (30.5%) so as for the patients (34.7%). Key messages The reduction of a waiting time of doctors’ appointment, creations of an electronic queue and a remote consultation service have to be organized to improve primary care system. There is inconsistency in time preferences that have to be solved: doctors prefer to work in morning time and many patients can visit clinics only in the evenings.