title: Why medical students do not like to join rural health service? An exploratory study in India.
abstract: BACKGROUND
  Inadequate, inequitable distribution of the medical workforce remains a challenge across the globe, and India is no exception. Odisha, a state in India faces a major shortage of doctors particularly in rural and remote areas. In order to address this challenge, it is essential to understand medical students' career plans, specialization preferences, choices of job location and sector, and views on working in rural and remote areas. This study explored the immediate and long-term career plans of final year medical students, their intended practice locations and underlying reasons for the choices.
  
  
  METHODS
  A cross-sectional survey was conducted in all the medical colleges (three government and three private) in the state of Odisha. Through the systematic sampling method, data were gathered from 390 final year students. A semi-structured questionnaire was administered to the students and data were analyzed using SPSS version 20.
  
  
  RESULTS
  Of the 390 students, 290 (74.35%) were from a government college. The most preferred immediate career goal was postgraduation studies (45.9% of students in government medical schools and 54% in private). About 17% of government students and 9% of private students showed willingness to work in rural areas, in the long run. Nearly 44.5% mentioned opportunities for career growth, followed by the possibilities for higher education (26.8%) as major the factors for preferring an urban posting. Similarly, higher pay scales, better working conditions were major factors for preferring the private sector. Most of the students maintained that good housing, better salaries, and adequate facilities at the workplace would attract more students toward rural service.
  
  
  CONCLUSIONS
  Since public funded medical students are not motivated to serve in rural settings, increasing the number of places or establishing new medical institutions may not be an effective solution to the issue. Approaches such as extended clinical apprenticeship in rural health facilities, long-term community engagement during medical studentship could be considered.
authors.affiliation: Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, Odisha, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Nallala
authors.affiliation: Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, Odisha, India.
authors.forename: Subhashisa
authors.initials: S
authors.lastname: Swain
authors.affiliation: Public Health Division, Indian Institute of Public Health-Bhubaneswar, Odisha, India.
authors.forename: Sanju
authors.initials: S
authors.lastname: Das
authors.affiliation: HIV Division, Public Health Foundation of India, New Delhi, India.
authors.forename: Shravan K
authors.initials: SK
authors.lastname: Kasam
authors.affiliation: Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, Odisha, India.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Pati
keywords: Career choice; health workforce; medical students; public sector; rural health