Determinant factors to the rural and remote medical workforce in Maluku Islands of Indonesia: A cross-sectional study

Abstract Background Many factors contribute to engagement in rural and remote medical practice but little is known about the determinant factors of rural and remote medical practice in the such remote locations as the Maluku Province of Indonesia. This study describes determinants, preferences and intentions of doctors in the rural and remote practice. Methods An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of workforce, preference for rural practice and intention to remain in rural and remote Maluku were analysed using Chi-square tests and logistic regression. Results A total of 324 responses (79% response rate) were recorded comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Graduating from Pattimura University was associated with a nearly twofold rate of current rural practice and preference for future rural practice compared to graduates of other universities, and also predicted intention to stay rural. Those with rural background were twice as likely to prefer future rural practice and intend to stay rural. Younger age was associated with twofold odds of current rural practice, preferred future rural practice, and intention to stay rural. Smaller salary was associated with current rural practice. Smaller take home pay predicted current rural practice, but negatively impacted preference for future rural practice and intention to remain rural (OR < 1). Being in their early career was associated with current rural practice, and with preferred future rural practice and intention to stay rural. Being currently in a rural practice strongly predicted preferred future rural practice and intention to remain in rural practice (OR 15). Conclusion This study provides evidence that rural background predicts rural preference and intention, and shows the importance of a regional medical school in supplying doctors to a rural and remote region of Indonesia with persistent medical workforce shortage. Sustained collaboration between medical schools and local government to implement relevant strategies is needed to improve the recruitment and retention of rural doctors.