Joshi Anushree, Panchamia Jallavi, Mavalankar Dileep, Sharma Bharati
Department of Health Policy, Management and Behavioural Science, Indian Institute of Public Health Gandhinagar, IIPHG.
PLoS One. 2025 Jun 18;20(6):e0325820. doi: 10.1371/journal.pone.0325820. eCollection 2025.
This study aimed to explore and describe the experiences of specialist physicians at rural community health centers (CHCs) and determine the factors accounting for their retention and attrition in Rajasthan, India. Twenty-one medical professionals from different public health facilities in Rajasthan, selected through purposive sampling, were interviewed in depth. Strauss and Corbin's grounded theory approach was used to develop a theory/model. Open, axial and selective coding were used to identify the major themes/categories and develop the core category of the model. Strauss and Corbin's paradigm model was employed to establish linkages among the categories structured in terms of conditions, action-interaction strategies and consequences to explore the experiences of specialist physicians. The central theme of the model, 'The struggle of preserving Self-esteem and Professional identity', captures the experiences of specialist physicians working at the rural CHCs in Rajasthan's public healthcare system. The disadvantages of an underdeveloped rural setting, local political climate and various healthcare system factors challenge the specialists' self-esteem and professional identity culminating in their decision to remain or quit the system. This further leads to their acute shortage in the system which affects the quality and provision of rural healthcare services in the state. The state government and essential stakeholders must collaborate to enact policies addressing specialist physicians' personal and professional needs, which include improving developmental infrastructure, healthcare system processes, local governance and accountability. Such policy packages can generate sustainable solutions to mitigate the high attrition rate of specialists in rural CHCs and strengthen rural healthcare services in Rajasthan.
本研究旨在探索和描述农村社区卫生中心（CHC）专科医生的经历，并确定印度拉贾斯坦邦影响他们留任和离职的因素。通过立意抽样从拉贾斯坦邦不同公共卫生机构选取了21名医学专业人员进行深入访谈。采用施特劳斯和科尔宾的扎根理论方法来构建理论/模型。运用开放式编码、轴心式编码和选择性编码来识别主要主题/类别，并构建模型的核心类别。采用施特劳斯和科尔宾的范式模型来建立条件、行动 - 互动策略和后果方面结构化的类别之间的联系，以探究专科医生的经历。该模型的中心主题“维护自尊和职业身份的斗争”斗争”，体现了在拉贾斯坦邦公共医疗系统农村社区卫生中心工作的专科医生的经历。农村发展滞后、当地政治气候以及各种医疗系统因素带来的不利影响，对专科医生的自尊和职业身份构成挑战，最终导致他们决定留在或离开该系统。这进而导致该系统中专科医生严重短缺，影响该邦农村医疗服务的质量和提供。邦政府和重要利益相关者必须合作制定政策，满足专科医生的个人和职业需求，其中包括改善发展基础设施、医疗系统流程、地方治理和问责制。这样的政策组合能够产生可持续的解决方案，以缓解农村社区卫生中心专科医生的高流失率，并加强拉贾斯坦邦的农村医疗服务。
