Factors associated with the rural and remote practice of medical workforce in Maluku Islands of Indonesia: a cross-sectional study

Abstract

Background Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province. Methods An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression. Results A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03–11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24–31.1), and have no additional practice (OR 2.78, CI 1.34–5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42–17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09–8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10–0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05–3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06–4.09), currently practising in RR Maluku (OR 8.23, CI 3.27–20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13–0.70). Conclusion This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.

Attracting, Recruiting, and Retaining Medical Workforce: A Case Study in a Remote Province of Indonesia

“…[17,18] Although PUFM has no stated policy/quota for rural background students, each year it admitted 20-25% of students from rural and remote districts, both districts without or with the memorandum of understanding (MoU) with the faculty. [3,19] The selection was done on two levels, by the district's officers for screening purposes and later by the university. However, the selection procedure was not documented in detail.…”

“…[24,33] However, for the medical internship, the salary and incentives known as Basic Living Expenses (BLE) are smaller and deemed to have not met the necessities of life compared to the volume of work assigned to the interns. [33,34] Besides the support given to their physicians with bonded placements, most districts also provide incentives for physicians from national employment schemes such as Nusantara Sehat and PGDS. Hence, these physicians with national appointments receive extra incentives.…”

“…Indonesia, one LMIC the Asia Pacific, has suffered from a chronic medical workforce shortage. [3,4] Although Indonesia barely achieves the national standards for the underlying health indicators [5], there are limited published studies describing the approaches implemented by the Indonesian government regarding recruitment and retention of the medical workforce, nationally or regionally. This study focuses on the Maluku province of Indonesia, which includes some of the most remote, isolated, and underserved islands.…”

“…This study focuses on the Maluku province of Indonesia, which includes some of the most remote, isolated, and underserved islands. [3,5] [3] The remote and isolated nature of the province is reported as having discouraged physicians from living and working there. [6][7][8] With less health infrastructure and facilities, the ratio of physicians per population is 1:7269.…”

Do General Practitioners in a Visiting Medical Officer Arrangement Improve the Perceived Quality of Care of Rural and Remote Patients? A Qualitative Study in Australia

“…Furthermore, the decisions of health workers to practice rurally are informed by non-financial incentives, including job satisfaction, career advancement opportunities, and professional development [ 12 ]. Other studies have identified strategies to sustain rural health workforce, including recruiting more doctors with rural background [ 13 , 14 , 15 ], longer rural immersions and regional training [ 14 , 15 , 16 ], and enhancing rural training opportunities and sustainable rural working condition for overseas trained doctors [ 17 ].…”