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ABSTRACT
Background
Medical internship is a key period for doctors’ individual career planning and also a transition period for the broader labour market.
Objectives
We aimed to understand the complex set of factors influencing the career intentions and decisions of junior doctors, post-internship in Kenya and Uganda.
Methods
We conducted semi-structured interviews with 54 junior medical officers and 14 consultants to understand doctors’ internship experiences and subsequent employment experiences. We analysed the data using a mix of a direct content approach, informed by an internship experience and career intentions framework developed primarily from high-income country literature, alongside a more inductive thematic analysis.
Results
Echoing the internship experience and career intentions framework, we found that clinical exposure during internship, work–life balance, aspects of workplace culture such as relationships with consultants and other team members, and concerns over future job security and professional development all influenced Kenyan and Ugandan doctors’ career preferences. Additionally, we added a new category to the framework to reflect our finding that interns might want to ‘fill a health system gap’ when they choose their future careers, based on what they witness as interns. However, often career intentions did not match career and employment decisions due to specific contextual factors, most importantly a shortage of job opportunities.
Conclusion
We have shown how internship experiences shape medical doctors’ career intentions in Kenya and Uganda and highlighted the importance of job availability and context in influencing doctors’ career choices.
Responsible Editor Stig Wall
Responsible Editor Stig Wall
Author contributions
YZ, DG, CN, RT and ME designed the study. YZ, DM and RT contributed to data collection in study countries. YZ oversaw data collection, conducted analysis and wrote the first draft of the manuscript. DSA, CB, DG, SM, CN, TRO, ER, RT and ME provided critical feedback on the first draft of the manuscript and read and approved the final manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Ethics and consent
Ethical approvals for the study were issued by the Oxford Tropical Research Ethics Committee (OxTREC 563–20 and OxTREC 518–21), the Kenya Medical Research Institute (KEMRI) (SERU 4071), the Makerere University School of Public Health, Research Ethics Committee and the Uganda National Council for Science and Technology in Uganda (SPH-2021-168 and HS2062ES).
Paper context
Main findings: Internship experiences shape medical doctors’ career intentions in Kenya and Uganda, however job availability and context rather than preferences may dominate doctors’ career choices.
Added knowledge: Career intentions differed from employment decisions due to specific contextual factors, most importantly a shortage of job opportunities in Kenya and Uganda
Global health impact for policy and action: Countries need to improve workforce planning to ensure a better balance between supply and demand of labour so that doctors feel enabled to continue in their intended careers
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Supplementary data
Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2272390.