# Influences of Western Cape community service doctors’ choice regarding public, rural practice

## TL;DR

This study explores why some doctors in South Africa's Western Cape choose to work in rural areas, finding that personal background and positive experiences in rural settings are key factors.

## Contribution

The study identifies specific factors influencing rural practice intentions among community service doctors in South Africa.

## Key findings

- Doctors with rural upbringing are 6.5 times more likely to consider rural practice.
- Rural internship placement increases rural practice intentions by 7.7 times.
- Personal safety, job satisfaction, and mental health are key influences on rural employment decisions.

## Abstract

Staff shortages in rural areas have led to unequal healthcare access in South Africa. The compulsory community service programme aims to address this disparity; but to be effective, it must encourage doctors to remain in rural facilities beyond their service periods. Identifying factors that influence their decisions to stay is crucial for developing strategies to improve rural doctor retention. The aim is to describe the important factors influencing Western Cape community service doctors’ choice of whether they will seek employment in public rural practice.

An observational cross-sectional study with correlational analysis was conducted using an internet-based questionnaire. This study was conducted on community service doctors who were employed in the Western Cape in 2022.

Eighty-six doctors participated, with 8% intending to work in rural practice in 2023 and 21% considering it in the future. Significant factors associated with rural practice intentions included rural upbringing (6.5 times more likely), rural internship placement (7.7 times more likely) and rural community service (3.5 times more likely). Key influences were personal safety, job satisfaction and mental health.

The proportion of doctors considering rural practice remains low. Policy revisions should focus on preferentially enrolling medical students with rural backgrounds and placing community service doctors in rural areas, alongside efforts to create safe, satisfying work environments that support mental health.

This study enhances the understanding of retaining healthcare professionals in underserved rural areas, addressing primary healthcare challenges in the African context.