The Chilean Rural Practitioner Programme: a multidimensional strategy to attract and retain doctors in rural areas.
Developing countries currently face internal and external migration of their health workforce and interventions are needed to attract and retain health professionals in rural areas. Evidence of multidimensional interventions, however, is scarce. This study explores a long-standing strategy to attract and retain doctors to rural areas in Chile: the Rural Practitioner Programme. The main objective is to describe the programme, characterize its multidimensional set of incentives and appraise preliminary programme outcomes.Retrospective national data were employed to examine recruitment, retention and incentives provided to extend the length of stay and motivate non-clinical work. The programme has successfully recruited a large number of applicants, with acceptance rates close to 100%. Retention rates are nearly 100% (drop-outs are exceptional), but only 58% of participants stay for the maximum period. Areas with greater work difficulty are attracting the best-ranked applicants, but incentives to engage in community projects, management responsibilities, continuous medical education and research have achieved mixed results. Rural doctors are satisfied with their experience and 70% plan to practise as specialists in a referral hospital.The programme has successfully matched the interests of physicians in specialization with the country's need for rural doctors. However, a gap might be forming between the demand for certain specialties and what the programme can offer. There is a need to conciliate both parties, which will require a more refined strategy than before. This should be grounded in robust knowledge based on programme outcomes and evidence of the interests and motivations of health professionals.
Peña
Sebastian
S
National Institute for Health and Welfare, Division of Welfare and Health Policies, Helsinki, Finland.
Ramirez
Jorge
J
Becerra
Carlos
C
Carabantes
Jorge
J
Arteaga
Oscar
O
D002677:Chile; D003258:Consumer Behavior; D004502:Education, Medical, Continuing; D004777:Environment; D006801:Humans; D010560:Personnel Selection; D010563:Personnel Turnover; D010820:Physicians / Q000458:organization & administration*; D015397:Program Evaluation; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D012456:Salaries and Fringe Benefits; D012944:Social Support
Rev Med Chil. 2002 Aug;130(8):917-24
12360803
Hum Resour Health. 2008 Nov 18;6:25
19017381
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005314
19160251
Health Policy. 1995 Apr-Jun;32(1-3):155-66
10156636
Can Fam Physician. 2005 Sep;51:1246-7
16926939
BMC Health Serv Res. 2008 Jan 23;8:19
18215313
Lancet. 2008 Feb 23;371(9613):668-674
18295024
Med J Aust. 2003 Jul 21;179(2):75-9
12864716
BMC Health Serv Res. 2009 May 29;9:86
19480656
JAMA. 2001 Sep 5;286(9):1041-8
11559288
Bull World Health Organ. 2004 Aug;82(8):595-600
15375449
Rev Med Chil. 2009 Aug;137(8):1099-104
19915777
Lancet. 2004 Nov 27-Dec 3;364(9449):1984-90
15567015
Can J Rural Med. 2004 Spring;9(2):82-8
15603680
Fam Med. 1997 Feb;29(2):115-8
9048172
N Engl J Med. 2005 Oct 27;353(17):1810-8
16251537
Bol Oficina Sanit Panam. 1975 Mar;78(3):203-11
123448
Health Policy Plan. 2007 May;22(3):128-38
17463013
Hum Resour Health. 2006 May 27;4:12
16729892