LAUSR

Abstract Background The shortage of qualified health workers in rural areas is a global concern. The question of how to attract more medical graduates to work in rural areas has drawn considerable attention. However, very few studies have analysed the association between medical graduates' initial intentions and whether they ultimately opt for rural practice, and no related studies have been conducted in China. Methods The cross-sectional survey was carried out in ten western provinces in China (Gansu, Kweichow, Inner Mongolia, Ningxia, Qinghai, Shaanxi, Sichuan, Tibet, Xinjiang, and Yunnan). No more than six medical schools in each province and no more than 100 medical students in each school were randomly selected. 4517 questionnaires were collected (response rate, 90·3%). However, only medical graduates who had found a job were included. Pearson's chi squared tests and binary logistic regression analyses were performed on data. Findings Of 482 medical graduates included in the analysis, 61·0% (293) disclosed an initial intention of rural practice when they began to look for a job, and 68·9% (332) ultimately found a job in a rural area. Among these 332 graduates, 213 initially intended to work rurally. An increase of 1·59 times was observed in the odds of ultimately opting for rural practice in the medical graduates who initially intended to work rurally (odds ratio [OR] 1·59, 95% CI 1·08–2·36). However, after adjusting for all of the demographic variables (gender, age, residence, specialty, type of medical school, and rural clinical clerkship), it reduced to an increase of 1.0 times (1·06, 0·57–2·00) and the association became statistically insignificant. A rural background (1·90, 1·01–3·59), majoring in a specialty of non-clinical medicine (4·69, 1·80–12·24), and studying in junior colleges or below (8·87, 3·67–21·45) significantly increased the odds of ultimately opting for rural practice. Interpretation A univariate association was identified between medical graduates' initial intentions and whether they ultimately opted for rural practice. However, the initial intentions of medical graduates did not guarantee the eventual outcomes, and it could not be concluded that all medical graduates who opted for rural practice had a genuine desire to work in rural areas. Further study is required on how to increase the likelihood that those who intend to work in rural practice fulfil these intentions, and how to ensure that there continue to be those with other intentions who eventually opt to work rurally. Funding China Medical Board (number 10-029).