Exploring the Career Intentions of primary care doctors in Kuwait: A questionnaire survey

Problem

The recruitment and retention of primary care doctors have been one of the prominent dilemmas internationally. Kuwait has also been suffering from this problem, in which a high number of doctors have left clinical practice for administrative positions, and others have resigned from the Ministry of Health in Kuwait. As part of a wider study of recruitment and retention, this study aimed is to explore the career intentions of primary care doctors in Kuwait.

Approach

A cross-sectional survey of medical doctors working in primary care services in Kuwait was conducted. All primary care doctors working in a sample of primary are medical centres were included, with no limitations to the physicians’ age, nationality, or qualification. However, doctors working in specialised clinics, such as surgery, were excluded from the study and doctors currently in the family medicine training programme were excluded. The survey was distributed in 25 centres broadly representative of size and geographical location (urban vs less urban), representing more than >25% of the primary care centres in Kuwait. The survey instrument, which was designed for the UK, was adapted to fit the Kuwaiti health care system and piloted before distribution. Analyses included Chi-square tests and regression analysis.

Findings

One hundred ninety-one surveys were returned with 80.9% response rate. The majority of the participants were female, aged 35 to 44 years, and non-Kuwaitis. Approximately one-third of the participants were senior registrars and the majority, 27%, hold the qualification of medical degree only. Most were working in centres which operated 17 hours per day and covered a population of up to 25000. The most common five-year career plan was to increase teaching and research activities followed by increasing management responsibilities. However, 23.6% of participants stated their desire to leave primary care. Several factors were identified as important in contributing to participants’ decision to leave: workload, working hours, job satisfaction, and family commitments. Factors which would encourage them to stay in primary care were reduction in workload and working hours, increasing clinical autonomy and annual leave, providing protected time for education and increasing payment. An intention to leave primary care was associated with working for less than ten years, being currently dissatisfied, and being less satisfied with work in the last two years. Workload, working hours, and spending time on unimportant tasks were identified as important drivers by those intending to quit primary care. Reducing workload, reducing administrative tasks, and shorter clinic hours were significant encouraging factors for remaining in primary care.

Consequences

Work-related factors and job satisfaction were the leading influencers on primary care doctors decisions to leave practice in the next five years. Policies are required to address primary care physicians’ working conditions and create a more supportive environment to improve their retention.