Future medical student practice intentions: the South Africa experience

BACKGROUND: Primary care is a broad spectrum specialty that can serve both urban and rural populations. It is important to examine the specialties students are selecting to enter, future community size they intend to practice in as well as whether they intend to remain in the communities in which they trained. AIM: The goals of this study were to characterize the background and career aspirations of medical students. Objectives were to (1) explore whether there are points in time during training that may affect career goals and (2) assess how students’ background and stated motivations for choosing medicine as a career related to intended professional practice. SETTING: The setting for this study was the Nelson R. Mandela School of Medicine, located in Durban, South Africa. METHODS: We conducted a cross-sectional survey of 597 NRMSM medical students in their first, fourth, or sixth-year studies during the 2017 academic year. RESULTS: Our findings show a noticeable lack of interest in primary care, and in particular, family medicine amongst graduating students. Altruism is not as motivating a factor for practicing medicine as it was among students beginning their education. CONCLUSION: Selection of students into medical school should consider personal characteristics such as background and career motivation. Once students are selected, local context matters for training to sustain motivation. Selection of students most likely to practice primary care, then emphasizing family medicine and community immersion with underserved populations, can assist in building health workforce capacity. There are institutional, legislative, and market pressures influencing career choice either toward or away from primary care. In this paper, we will discuss only the institutional aspects.