Rural retention of new medical graduates from the Collaborative Project to Increase Production of Rural Doctors (CPIRD): a 12-year retrospective study

Physician scarcity in rural areas is a major obstacle to healthcare access, leading to health inequity worldwide. In Thailand, a special recruitment program of medical education [Collaborative Project to Increase Production of Rural Doctors (CPIRD)] was initiated with four different medical training tracks. No previous research has examined the rural retention of new medical graduates across the CPIRD tracks, compared with those receiving conventional medical education (Normal track). This study examines the public retention of rural physicians from different tracks of entry. A retrospective study was conducted in new medical graduates who entered Ministry of Public Health (MoPH) hospitals from January 2003 to October 2014, and followed up until June 2015, using administrative data from the Personnel Administration Division, MoPH. The CPIRD registry database was used to identify physicians’tracks of entry. Survival analyses and multiple logistic regression analyses were applied to compare the annual retention and the probability of 3-year retention of rural physicians. Results clearly demonstrated a high rural retention of CPIRD medical graduates, compared with their Normal track peers, regarding both lower annual resignation (HR 0.456, P < 0.001) and higher 3-year retention (OR 2.441, CI: 2.192, 2.719). Some variations of rural retention were revealed across the different CPIRD tracks. Evidence from this study can be used as part of the information to reshape the physician production policy to reduce health inequity in rural areas. 农村地区医生短缺是医疗可及性的主要障碍, 导致全球卫生不 公平。泰国实施了专门的医学教育招生制度, 即增加农村医生 合作培养项目（CPIRD）, 设有四个不同的医学培养渠道。此 前没有研究比较过 CPIRD 培养的医学毕业生与正常渠道培养 医学生留用农村地区的状况。本研究调查通过不同渠道入学 的农村医生在公共部门的留用情况。本研究为回顾性研究, 使 用公共卫生部 （MoPH）人员行政处管理数据, 研究对象为 2003 年1 月至 2014 年 10 月进入 MoPH 医院的应届医学毕 业生, 随访至2015 年 6 月。使用 CPIRD 登记数据库确定医 生的招生渠道。采用生存分析和多因素 Logistic 回归分析比 较农村医生的年留用率和 3 年留用率。结果显示 CPIRD 培养 的医学生农村留用情况明显优于正常渠道医学生, 年辞职率较 低 （HR=0.456, P