Relationship between personal characteristics of specialist physicians and choice of practice location in Iran.

Introduction: Uneven geographic distribution of physicians is a major healthcare issue in Iran. This study aimed to explore the relationship between personal characteristics of the recently graduated specialist physicians in Iran and their choice of practice location.

Methods: A cross-sectional study was conducted to extract information with regard to 3825 recently graduated specialist physicians from all medical schools across Iran between 2009 and 2012. The relationship between physicians' personal attributes and their desire to practise in underdeveloped areas was analyzed using χ2 test and logistic regression analysis.

Results: Birthplace, sex, exposure to rural practice before residency program, place of residence, and year of graduation were associated with physicians' desire to practise in an underdeveloped area. The logistic regression showed that female physicians were less likely to choose underdeveloped areas to practise as compared with their male counterparts (OR=0.659, 95%CI, 0.557-0.781, p≤0.001). Physicians who lived in underdeveloped areas were nine times more likely to choose underdeveloped areas to practise as compared with those living in other areas (OR=8.966, 95%CI, 4.717-17.041, p≤0.001). Physicians who did not have previous exposure to rural practice were 28% less likely to choose to serve in the underdeveloped areas as compared to those who had such exposure (OR=0.780, 95%CI, 0.661-0.922, p=0.004). Neither physicians' marital status nor their success in the board certification exam was associated with their choice of practice location.

Conclusions: It seems that increasing the enrollment of physicians with a rural background in residency programs may solve the problem of uneven distribution of specialist physicians in Iran. Because female physicians are less willing to work in the underdeveloped areas than male physicians, increasing the number of male student admissions to residency programs, particularly in certain specialties that are more in demand in the underdeveloped areas, could alleviate the problem of uneven distribution of physicians in the short run. Further, programs that support raising the admissions of female students with a rural background into local medical universities along with providing incentives to encourage them to live and work in rural areas should be put on the policy agenda.