Family medicine and primary health care: the role of undergraduate training on current practices and future considerations of junior doctors in South Africa

Mosam, Atiya
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Introduction: The South African government recently began the implementation of the new National Health Insurance (NHI) and Re-engineering of Primary Health Care (PHC) policy proposals (green paper) in order to achieve universal health coverage and health equity. One of the vital aspects of these policy proposals is the recruitment and retention of doctors within PHC in the public sector. This study therefore aims to examine the training, current practices and future intentions of doctors completing community service in 2010, 2011 and 2012 in order to ascertain which factors may be associated with employment in PHC. Methodology: The study was designed as a cross sectional study with an analytical component. Doctors in the cohorts of interest were contacted via email and requested to fill in an anonymous self-administered online survey. Univariate analysis was done to describe socio-demographic characteristics, current employment status and future intentions. Bivariate analysis was done to examine any associations between exposure to family medicine and PHC during undergraduate training, internship and community service, and employment in PHC. Results: The database yielded a sample of 350 doctors, of which 61 responded. Of the respondents, 35.59% worked as a private general practitioner whilst 11.86% work in public PHC. The study showed no statistically significant association between exposure to family medicine and PHC and employment in PHC but female gender was the socio-demographic variable found to be associated with PHC employment (p=0.02). Factors that deterred doctors from pursuing a specialization in family medicine were related to employment conditions such as poor resources and under staffing and not to factors related to the specialty itself such as an unchallenging scope of work or poor professional perception of the specialty. Conclusion: Whilst the study showed no association between exposure to family medicine and PHC and career choices in that field, it has highlighted that the conditions within the public service are the biggest deterrent to doctors. Thus whilst medical school admissions should aim to increase the number of students with characteristics positively associated with PHC employment such as female gender, it is important that the Department of Health in South Africa aims to Mosam, Atiya. 0003032K. MPH 2015 ensure that the conditions within the public service are optimized in order to recruit and retain as many doctors as possible in light of the human resource requirements of the new policy.
Research Report For Masters of Public Health 30 March 2015