Why do primary care doctors quit clinical practice in Kuwait? A qualitative study

Talk Code: 
V.2
Presenter: 
Abdulaziz Alhenaidi
Co-authors: 
Jill Morrison, Kate O'Donnell
Author institutions: 
Department of General Practice and Primary care, University of Glasgow.

Problem

The recruitment and retention of primary care doctors have been one of the prominent dilemmas internationally. Kuwait is also suffering from the same problem, in which a high number of doctors left clinical practice for administrative positions, and others have resigned from the Ministry of Health. Using a qualitative approach, this study aimed to explore the main factors influencing the decision to quit among primary care doctors in Kuwait.

Approach

Qualitative semi-structured interviews were conducted with twenty primary care doctors working in Kuwait. Participants were recruited during a previous cross-sectional study, in which participants asked if they wish to be involved in this interview study. Purposeful selection from those willing to participate was carried out to ensure representation by gender, age, and nationality (Kuwaiti vs non-Kuwaiti). Interviews were transcribed by professional transcribers, and thematic analysis was conducted.

Findings

Eleven interviews were done with males, of which three were Kuwaitis and eight were from other nationalities; nine interviews were conducted with female doctors, seven Kuwaitis, and two were from other nationalities. Participants age ranged from 29 to 68, although most were in their thirties. Although some participants had replied in the survey that they did not wish to quit their primary care job, during the interview they indicated that they would quit if the circumstances were right. Most participants felt that the ideal of primary care is not applied in Kuwait, with a lack of clinical autonomy frequently cited as an issue. Work-related factors, such as workload and working hours, were among the leading influencers to quit. Other issues related to health system organisation, e.g. the lack of appointment systems.. Although relationships with patients were cited as a positive factor, the increase in patient demand for documentation relating to sick leave was viewed as a particularly negative aspect of primary care work in Kuwait. Participants also talked about the shortage of doctors, and the discrepancy between governorates in the allocation of doctors and resources.Promotion systems were criticised as there is no formalised career development or promotions system, this was a particular difficulty for non-Kuwaitis. Introducing the concept of primary care doctors with a special interest was viewed as a positive way of supporting doctors’ retention in primary care. Increasing opportunities for Continuous Professional Development and medical education activities, with dedicated time allocated for such activities, were also suggested as key retention strategies.

Consequences

Work-related factors, clinical autonomy, and rules and regulations were the main issues influencing primary care doctors’ decisions to leave. Primary care reform policies, especially establishing appointment systems and primary care doctors with special interest might increase doctor’s retention. Increasing the recruitment of primary care doctors and decreasing the discrepancy of doctors and resources might also improve doctor’s retention.

Submitted by: 
Abdulaziz Alhenaidi
Funding acknowledgement: