Factors that Influence a Career Choice in Primary Care: a Mixed-methods Study among Medical Students Starting the Social Service Program in Honduras

Abstract

Medical students are not choosing primary care careers. This project was a mixed-method study aimed to identify factors that influence the decisions of Honduran medical students to choose a career in primary care. The study included a survey questionnaire applied to 234 last-year medical students and semi structured interviews to eight key informants. Career choice favors medical specialties. PC careers were the preferred career choice for 8.1% of students. Relationships between “sex” and “location where student lived” by specialty categories were statistically significant (P= 0.011 and 0.042). There were more male respondents preferring PC (8.8%); students who preferred PC came mainly from urban backgrounds (62.6%). The perceived monthly salary of specialties other than primary care was significantly higher than those of GPs, FPs and Pediatricians (p<0.001). Participants considered “making a difference”, income, teaching, prestige, and challenging work as the most important factors that influence career choice. Practice in ambulatory settings was significantly associated with a preference for primary care specialties (P=<0.05). Factor “patient-based care” was statistically significant (P=0.006) for selecting PC. Rationales behind the preference of a specialty appear to be based on a combination of ambition and prestige on one hand, and on personal and altruistic considerations on the other. There are several factors distinctive to medical students in Honduras: future work option, availability of specialties, and social factors including violence. A facilitator for PC selection in Honduras is the type of resources needed to practice a specialty. Social service participants from urban background who prefer primary care are mostly influenced by rural work and practice in ambulatory settings, while respondents with a rural background who prefer specialties are influenced by the possibility of making a positive difference in people´s lives. The study is a component of a strategy to strengthen primary care in the country that includes a public policy for strengthening PC workforce in Honduras. The results will be shared with Secretary of Health national authorities, including the Direction for Development of Human Resources, the National Council of Human Resources for Health, and academic authorities from UNAH. Policy advocacy is part of the plan for change.Doctor of Public Healt