What are the main motivating factors for young general practitioner trainees to work in rural areas in the Czech Republic?

PURPOSE: The global health workforce suffers long-term understaffing in remote and underserved areas. To attract young doctors for rural work, it is necessary to identify the main motivating factors.
MATERIALS AND METHODS: The pilot survey with 201 general practitioner trainees in the Czech Republic was conducted using a structured questionnaire. The response rate was 67%.
RESULTS: Not only financial support motivates general practitioner trainees for rural work. A combination of incentives from sources other than medical would greatly increase the chance for general practitioner trainees to work in rural regions.
CONCLUSIONS: To what extent can the survey outcomes relate with other European regions needs to be investigated further.

KEY MESSAGES

The main motivating factors leading general practitioner trainees to work in rural areas in the Czech Republic are finance, securing a suitable job for a partner and securing schooling for children, ideally all three fulfilled.

Contrary to common expectations, incentives shall be complex and focus on rural life in general.

One of the most difficult challenges for health systems in Europe is understaffing of rural surgeries [1]. The European Rural and Isolated Practitioners’ Association (EURIPA) represents a growing network of rural practitioners and national organisations across Europe working together to disseminate good practice, initiate research and influence policies [2]. This group is preparing a Europe-wide qualitative study of trainees in general practice (GP trainees) to find motivators and barriers to choosing careers in rural regions.

To assess the feasibility of this study, we recently performed a pilot survey among GP trainees in the Czech Republic. We approached 300 GP trainees (out of 645 in training that year) during a course conducted by the Institute for Postgraduate Health Education in Prague. A questionnaire was used to identify the main motivating factors (see Appendix). Out of 201 trainees that responded (response rate 67%), 145 were female and 60 did not have General Practice as their first career choice. Most trainees (48%) were considering a career as a rural GP, a small group of trainees (15%) had not decided yet, and more than one-third had decided against it (37%).

The main motivators identified are summarised in Table 1; number of respondents and motivating factors stated.

Table 1.

Number of respondents and motivating factors.

Motivators	First choice	Requalifying	Men	Women
Finance	104	45	46	97
Job for a partner	90	34	38	95
Schooling for children	112	47	45	110

Most importantly, 62% of those contemplating a career in rural general practice stated that they would have definitely decided for it if all top three factors were fulfilled. The main concern about a rural practice was the accessibility to subsequent secondary care facilities. In addition, we found that 86% of respondents felt they did not have access to relevant information on rural practice and 70% of respondents would appreciate a short-term training period in a rural practice as a part of the general practice training programme.

Our pilot study surveying GP trainees provided excellent response rates. Obviously, our findings in about one-third of all GP trainees in a single country, lack generalisability and should be considered as preliminary. Nonetheless, it is evident that contrary to common expectations, financial incentives are not the single most important motivation for a career in rural general practice. A Europe-wide survey is currently underway and its results will help policy makers decide which recruitment and retention strategies as well as supporting measures are most efficient [3-5]. We are grateful and positive that attention is finally given to a field neglected for many years.