Where have all the doctors gone? Career choices of Wits medical graduates

Objectives. To assess the distribution of University of the Witwatersrand (Wits) medical graduates from 1960 to 1994 with regard to private or public sector work, chosen specialist or generalist careers, and work in urban or rural areas, looking for secular trends and gender differences. Design. A cross-sectional analysis of the register of what was then the South African Medical and Dental Council (SAMDC) and a telephone interview survey of a sample of medical graduates, collecting retrospective career histories. Results. Thirty-six per cent of the sample was working predominantly in the public sector, while 47% of all years worked by graduates were in the public sector. Women graduates spent 68% of their years working in the public sector, compared with 36% for men. The majority (55%) of graduates in the sample who were working in the public sector cited academic and training aspects as the main reason for this choice. Conversely, nearly half (47%) gave income as the main reason for moving to the private sector. Forty per cent of graduates had specialised (46% of men, 22% of women), while 76% were working in the large urban areas. Conclusions. The findings highlight methodological problems with standard cross-sectional analysis of distribution of personnel. They also challenge several assumptions about the likelihood of Wits graduates working as generalists (60%), the voluntary contribution of graduates to the public sector, and in particular the value of women doctors to public service and primary care.