Final-Year Residents’ Intention to Practice in Non-Urban Areas of Indonesia: A Single Center, Cross-Disciplinary Study

Abstract Background The disparity between urban and nonurban areas of Indonesia to access secondary and tertiary healthcare remains challenging. Considering the changing landscape of the Indonesian healthcare system, the maldistribution of specialists must be addressed to ensure equity between urban and nonurban areas of Indonesia in accessing specialist-level care. It is pertinent to identify factors influencing final-year residents’ decision to pursue non-urban practice. Methods A sequential explanatory mixed-method design was adopted. Initially, a cross-sectional study was completed using a validated questionnaire targeting the whole cohort of final-year residents across all 34 residency programs in the Faculty of Medicine, Universitas Indonesia, grouped into clinical, paraclinical, and surgical specialties. Baseline data, including general characteristics, preferred area(s) for practice, and factors influencing the decision to pursue non-urban practice, were gathered. Factors were rated on a 5-point Likert scale, and their associations with the preferred area were assessed using the Jonckheere-Terpstra test. The final set of factors associated with the preferred practice area was determined using multivariate logistic regression analysis. Three focus group discussions, each for a specialty group, were conducted for further exploration, followed by a thematic analysis. Results 322 respondents from 30 out of 34 specialty programs in FMUI participated in the first phase of the study. Only 80 (24.94%) residents aimed for non-urban practice. 66.8% of the respondents were married, 24.9% had experienced living in rural area (s), and 40.4% experienced non-urban rotation during residency. Around 14% of the respondents were sent by governmental institutions for residency, and 9,6% had official work ties after completion. In multivariate analysis, two main factors were positively correlated with the preference for non-urban practice: being supported by the government (aOR 2.291; 95% CI 1.08–14.8, p = 0.030) and surgical specialties (aOR 2.796; 95% CI 1.10–7.12, p = 0.031). Proximity to family and friends was negatively correlated with non-urban practice (aOR 0.691; 95%CI 0.48–0.99, p = 0.041). The FGDs were attended by 8, 4, and 6 residents from clinical, paraclinical, and surgical-related specialties, respectively. Four major themes were identified: factors supporting meaningful residency training, considerations of practising as a specialist, factors supporting non-urban specialist practice, and recommendations to support non-urban specialist practice. Conclusion Only a small proportion of final-year residents were willing to pursue non-urban practice. Our study provides valuable insights into factors influencing residents’ decision to do non-urban practice. While familial factors remain an important determinant, monetary support with clear work ties after residency by the government seemed to be a plausible solution to support non-urban specialist practice. Multifaceted approaches need to be taken to solve this enigmatic problem.