Physician scarcity in underdeveloped areas of Turkey: what do new graduate physicians think?

INTRODUCTION

A sufficient and balanced distribution of physicians plays a key role in access to high quality healthcare services. However, this issue presents serious problems globally. Turkey is currently experiencing physician shortages, with insufficient numbers of physicians in its rural and underdeveloped areas. The objectives of this study were to identify the views of new graduate physicians, prior to employment, on working in underdeveloped areas, in order to discover factors impacting their desire to work in these areas, and to show the actual geographic distribution of physicians in Turkey. This provides the basis for discussing future policies.

METHODS

This study was conducted in Turkey from September to November 2009. All physicians (N=4753) who graduated in 2009 were included in the study via online questionnaires. The response rate was 78%. Variables potentially related to physicians' decisions to work in underdeveloped areas were analyzed using the χ(2) test. To discover the imbalance in geographic distribution of physicians, data collected by the Turkish Ministry of Health (MoH) were re-analyzed. Physician density was calculated for the six zones determined by the MoH according to socioeconomic development.

RESULTS

Of the physicians who participated, 52.5% were male and 13.5% expressed a desire to work in underdeveloped areas. Male physicians were more likely to work in underdeveloped areas (17.5% and 9.1%, respectively; p<0.05). There was a significant relationship between desire to work in underdeveloped areas, regions of longest stay and birthplace (p<0.05). Physicians who had lived for a significant period in areas with a high number of underdeveloped cities (Southeastern and Eastern Turkey) and those who were born in underdeveloped cities were more likely to wish to work in these areas. The most influential factor for working in these areas was higher salaries.

CONCLUSIONS

Physicians who have particular socioeconomic backgrounds such as rural origin and lower background-family income are more likely to have be motivated to work in underdeveloped areas. They are also more likely to accept work in these areas if financial and non-financial opportunities are provided. The findings of this study provide guidance for those revising health workforce policies.

Integration of GARD Turkey national program with other non-communicable diseases plans in Turkey

For the prevention and control of non-communicable diseases (NCD), an action plan on NCDs is intended to support coordinated, comprehensive and integrated implementation of strategies and evidence-based interventions across individual diseases and risk factors, especially at the national and regional levels by World Health Organization (WHO). The Global Alliance against Chronic Respiratory Diseases (GARD) is making every attempt to align with WHO's non-communicable diseases action plan. GARD activities have been commenced in over 40 countries and in 11 countries an integrated NCD action plan is being prepared or has already been initiated. This integrated approach of GARD has also targeted to GARD Turkey project. The Turkish Ministry of Health has decided to apply this national control program in conformity with other NCD action plans. This article is intended to summarize these integration efforts of GARD Turkey (the National Control Program on Chronic Airway Diseases) with other NCD national programs.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.