Putri Likke Prawidya, Russell Deborah Jane, O'Sullivan Belinda Gabrielle, Kippen Rebecca
Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia.
Front Med (Lausanne). 2021 May 13;8:594695. doi: 10.3389/fmed.2021.594695. eCollection 2021.
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. 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. 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). 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.
印度尼西亚偏远地区医生短缺是实现公平医疗服务面临的挑战之一。了解与医生工作地点相关的因素对于克服地理分布不均至关重要。对医生职业生涯早期阶段进行重点分析可为加强本土偏远地区劳动力发展提供证据。这是一项针对印度尼西亚职业生涯早期（实习后1至5年）医生的横断面研究，包括一项关于人口统计学特征以及成长地点、医学见习（医学院学习期间的实习地点）、实习和当前工作地点的在线自填式调查。采用多变量逻辑回归来检验与偏远地区当前工作相关的因素。在3176名活跃的临床医生中，8.9%在偏远地区执业。与非偏远地区的同行相比，在偏远地区工作的医生更有可能是男性（比值比1.5，置信区间1.1 - 2.1）或未婚（比值比1.9，置信区间1.3 - 3.0），童年一半以上时间在偏远地区度过（比值比19.9，置信区间12.3 - 32.3），完成过偏远地区的见习（比值比2.2，置信区间1.1 - 4.4）或实习（比值比2.0，置信区间1.3 - 3.0），目前参与农村激励计划（比值比18.6，置信区间12.8 - 26.8）或以前参与过这些计划（比值比2.0，置信区间1.3 - 3.0），是政府雇员（比值比3.2，置信区间2.1 - 4.9），或在实习后但在当前职位之前曾在农村或偏远地区工作过（比值比1.9，置信区间1.2 - 3.0）。我们的结果表明，通过投资于选拔有偏远地区背景的医学生、在医学课程中增加更多偏远地区见习、在偏远地区安排更多医生实习以及提供经济激励等策略，可促进印度尼西亚偏远地区医疗劳动力的建设。其他需要考虑的因素包括扩大农村地区的政府就业机会，以实现印度尼西亚医生更公平的地理分布。
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