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

How can equity be achieved in the distribution of health workers between urban and rural areas? Are medical students of rural origin really more likely to practice in a rural area after graduation? This study aimed to investigate the career choices of medical graduates of rural origin in the South African context, and to determine what proportion of rural origin students are currently practising in a rural area.

The findings suggest that the South African situation conforms to the findings in other countries, that is:

• rural origin medical students are more likely to choose rural careers than urban origin students are
• rural origin graduates are also more likely to choose general practice

The paper concludes that:

• recruiting larger numbers of rural origin graduates may alleviate shortages of doctors in rural South Africa as a long term strategy
• applicants to medical schools, who express an initial interest in primary care or general practice, are more likely to eventually practice in rural areas
• if more rural origin students are selected and eventually practice in rural areas, it will impact positively on service delivery because there will be more staff in rural hospitals, and they will understand the local language and culture

The paper recommends that:

• the National Department of Health negotiate incentives or conditional grants to encourage medical universities to enrol more students of rural origin
• the selection criteria of the medical faculties be reviewed with respect to rural origin
• the career aspirations of applicants to medical school be taken into account in selection, particularly with respect to primary care or general practice
• the enrolment of rural origin students be monitored at all medical schools on an ongoing basis
• the proportion of rural origin graduates who return to practice in rural areas be further monitored, with a larger sample size in a subsequent study