Motivating the next generation for primary care in rural Vietnam: insights from medical students and the 585 Policy

Abstract

Abstract Background Primary health care (PHC) plays a central role in promoting equitable access to health services in Vietnam. However, workforce shortages and unequal distribution of physicians, particularly in remote and disadvantaged areas, remain major challenges. To address this, the Ministry of Health implemented the 585 Policy, deploying young doctors with postgraduate training to underserved regions. Understanding medical students’ perceptions of PHC and related workforce policies is crucial for sustaining such initiatives. Methods An online cross-sectional survey was conducted among 215 medical students from 16 universities across Vietnam between March 2019 and February 2020. A structured questionnaire was used to assess (1) students’ perceptions of PHC and the 585 Policy, (2) key motivators influencing their willingness to participate in the 585 Policy, and (3) factors associated with students’ perceptions of PHC and the 585 Policy. Results Among 215 participants, most were Doctor of Medicine students (77.7%), with the remainder from Preventive Medicine, Traditional Medicine, and Dentistry. Major concerns about PHC included poor facility conditions (77%), limited career advancement (75%), and inadequate continuing education (70%). Perceptions of the 585 Policy were generally positive, particularly regarding training opportunities, financial support, and job security (>70%). However, eligibility criteria (27%) and mandatory services in underserved areas (<55%) received lower support. Key motivators for participation were specialist training opportunities (81%), continuing medical education (74%), and permanent contracts at central hospitals. In multivariable analyses adjusted for university, major, gender, ethnicity, age, academic performance, marital status, residence type, number of siblings, and perceived financial burden, students in non-MD programs had significantly less negative perceptions of PHC than MD students (β = −4.55, 95% CI: −7.71 to −1.39). Older age and living outside dormitories were associated with more negative PHC perceptions (β = 1.30, 95% CI: 0.54 to 2.07; β = 4.75, 95% CI: 1.12 to 8.37, respectively). In the model assessing perceptions of the 585 Policy, academic major was the only significant factor, with non-MD students reporting more positive perceptions than MD students (β = 2.37, 95% CI: 0.87 to 3.87). Conclusions Medical students recognized the importance of PHC and the value of the 585 Policy but reported concerns about infrastructure, further education, and limited career development. Findings highlight the need for improved working conditions and clearer professional pathways to attract and retain future physicians in primary health care settings.