TY - JOUR
T1 - Factors Associated With Working in Remote Indonesia
T2 - A National Cross-Sectional Study of Early-Career Doctors
AU - Putri, Likke Prawidya
AU - Russell, Deborah Jane
AU - O'Sullivan, Belinda Gabrielle
AU - Kippen, Rebecca
N1 - Funding Information:
The authors thank dr. Maxi Rein Rondonewu, DHSM, MARS, dr. Mawari Edy, M. Epid, Tumpal Pardomuan Hendriyanto, S. Kom, M.Sc (PH), and Ananta Dwi Saputra, S. Kom from BPPSDM MoH and Dr. dr. Andreasta Meliala, DPH, M. Kes, MAS from Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada for support in conducting this survey. We also thank the survey participants for their time and sharing their experiences. Funding. The research was funded by LPDP (Endowment Fund for Education) Indonesia and the Monash University Student Support Fund. The first author received a PhD scholarship from LPDP Indonesia.
Publisher Copyright:
© Copyright © 2021 Putri, Russell, O'Sullivan and Kippen.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/5/13
Y1 - 2021/5/13
N2 - Background: Doctor shortages in remote areas of Indonesia are amongst challenges to provide equitable healthcare access. Understanding factors associated with doctors' work location is essential to overcome geographic maldistribution. Focused analyses of doctors' early-career years can provide evidence to strengthen home-grown remote workforce development. Method: This is a cross-sectional study of early-career (post-internship years 1–5) Indonesian doctors, involving an online self-administered survey on demographic characteristics, and; locations of upbringing, medical clerkship (placement during medical school), internship, and current work. Multivariate logistic regression was used to test factors associated with current work in remote districts. Results: Of 3,176 doctors actively working as clinicians, 8.9% were practicing in remote districts. Compared with their non-remote counterparts, doctors working in remote districts were more likely to be male (OR 1.5,CI 1.1–2.1) or unmarried (OR 1.9,CI 1.3–3.0), have spent more than half of their childhood in a remote district (OR 19.9,CI 12.3–32.3), have completed a remote clerkship (OR 2.2,CI 1.1–4.4) or internship (OR 2.0,CI 1.3–3.0), currently participate in rural incentive programs (OR 18.6,CI 12.8–26.8) or have previously participated in these (OR 2.0,CI 1.3–3.0), be a government employee (OR 3.2,CI 2.1–4.9), or have worked rurally or remotely post-internship but prior to current position (OR 1.9,CI 1.2–3.0). Conclusion: Our results indicate that building the Indonesian medical workforce in remote regions could be facilitated by investing in strategies to select medical students with a remote background, delivering more remote clerkships during the medical course, deploying more doctors in remote internships and providing financial incentives. Additional considerations include expanding government employment opportunities in rural areas to achieve a more equitable geographic distribution of doctors in Indonesia.
AB - Background: Doctor shortages in remote areas of Indonesia are amongst challenges to provide equitable healthcare access. Understanding factors associated with doctors' work location is essential to overcome geographic maldistribution. Focused analyses of doctors' early-career years can provide evidence to strengthen home-grown remote workforce development. Method: This is a cross-sectional study of early-career (post-internship years 1–5) Indonesian doctors, involving an online self-administered survey on demographic characteristics, and; locations of upbringing, medical clerkship (placement during medical school), internship, and current work. Multivariate logistic regression was used to test factors associated with current work in remote districts. Results: Of 3,176 doctors actively working as clinicians, 8.9% were practicing in remote districts. Compared with their non-remote counterparts, doctors working in remote districts were more likely to be male (OR 1.5,CI 1.1–2.1) or unmarried (OR 1.9,CI 1.3–3.0), have spent more than half of their childhood in a remote district (OR 19.9,CI 12.3–32.3), have completed a remote clerkship (OR 2.2,CI 1.1–4.4) or internship (OR 2.0,CI 1.3–3.0), currently participate in rural incentive programs (OR 18.6,CI 12.8–26.8) or have previously participated in these (OR 2.0,CI 1.3–3.0), be a government employee (OR 3.2,CI 2.1–4.9), or have worked rurally or remotely post-internship but prior to current position (OR 1.9,CI 1.2–3.0). Conclusion: Our results indicate that building the Indonesian medical workforce in remote regions could be facilitated by investing in strategies to select medical students with a remote background, delivering more remote clerkships during the medical course, deploying more doctors in remote internships and providing financial incentives. Additional considerations include expanding government employment opportunities in rural areas to achieve a more equitable geographic distribution of doctors in Indonesia.
KW - career choice
KW - health workforce maldistribution
KW - low- and middle-income countries
KW - physician practice
KW - professional practice location
KW - rural health services
UR - http://www.scopus.com/inward/record.url?scp=85107200832&partnerID=8YFLogxK
U2 - 10.3389/fmed.2021.594695
DO - 10.3389/fmed.2021.594695
M3 - Article
AN - SCOPUS:85107200832
VL - 8
JO - Frontiers in Medicine
JF - Frontiers in Medicine
SN - 2296-858X
M1 - 594695
ER -