title: Factors affecting willingness to practice medicine in underserved areas: a survey of Argentine medical students.
abstract: BACKGROUND
  Previous research has explored the effect of motivations, incentives and working conditions on willingness to accept jobs in rural and remote areas. These studies demonstrated that difficult working conditions, low job satisfaction and remuneration, and poor security, predisposed new medical graduates to select cities instead of rural districts. Since Argentina has a critical shortage of health staff in rural and low-income marginal suburban settings, and limited qualitative and quantitative local research has been done to address this issue, the present study was developed to assess the factors associated with the willingness of medical students to work in low-resource underprivileged areas of the country after graduation.
  
  
  METHODS
  A cross-sectional descriptive design was used with data collected from a self-administered questionnaire and using quantitative analysis methods. A total of 400 eligible second-year medical students were invited to participate in a survey focused on sociodemographic characteristics, incentives and working conditions expected in deprived areas, extrinsic and intrinsic motivations, university medical education and government promotion policies.
  
  
  RESULTS
  Twenty-one per cent of medical students showed a strong willingness to work in a deprived area, 57.3% manifested weak willingness and 21.5% unwillingness to work in a low-resource setting. Being female, of older age, not having a university-trained professional parent, previous exposure or service in a poor area, choice of pediatrics as a specialty and strong altruistic motivations were highly associated with the willingness to practice medicine in rural or underprivileged areas. Only 21.5% of respondents considered that medical schools encourage the practice of medicine in poor deprived regions. Likewise, only 6.2% of students considered that national public health authorities suitably stimulate physician distribution in poorer districts.
  
  
  CONCLUSIONS
  One-third of students expressed high altruistic motivations and should therefore be encouraged during their careers. Better remuneration and the assurance of a position at an urban hospital in the future may tip the choice in favor of underprivileged regions. Since most respondents said that neither government nor medical schools sufficiently encourage the practice of medicine in poor deprived regions, government policy-makers should recommend changes in resource allocation to better promote official proposals and opportunities to work.
authors.affiliation: School of Medicina, Austral University, Buenos Aires, Argentina. raborracci@gmail.com.
authors.forename: Raul A
authors.initials: RA
authors.lastname: Borracci
authors.affiliation: School of Medicina, Austral University, Buenos Aires, Argentina. piedralta@gmail.com.
authors.forename: Eduardo B
authors.initials: EB
authors.lastname: Arribalzaga
authors.affiliation: School of Medicine, Austral University, Buenos Aires, Argentina. juan.lucio1989@gmail.com.
authors.forename: Juan L
authors.initials: JL
authors.lastname: Couto
authors.affiliation: Physiology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina. mdvorkinster@gmail.com.
authors.forename: Mario
authors.initials: M
authors.lastname: Dvorkin
authors.affiliation: Physiology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina. ahuadguerrero@aol.com.
authors.forename: Rodolfo A
authors.initials: RA
authors.lastname: Ahuad Guerrero
authors.affiliation: Business and Social Sciences University, Buenos Aires, Argentina. cfernandez@uces.edu.ar.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernandez
authors.affiliation: Business and Social Sciences University, Buenos Aires, Argentina. lferreira@uces.edu.ar.
authors.forename: Luis N
authors.initials: LN
authors.lastname: Ferreira
authors.affiliation: Remediar Program, Department of Health, University of Buenos Aires, Buenos Aires, Argentina. lcerezo@remediar.gov.ar.
authors.forename: Leticia
authors.initials: L
authors.lastname: Cerezo
mesh_terms: D001118:Argentina; D001291:Attitude of Health Personnel; D002321:Career Choice; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D009042:Motivation; D011365:Professional Practice Location; D019035:Rural Health Services; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult
keywords: Education; Health Needs Assessment; Professional conduct; South America; Undergraduate; Workforce