Examining medical doctors’ internship training experience and labour market transition in Kenya

Kenya has a severe shortage of doctors. Despite medical schools increasing the numbers of medical officers (MO) in training, less than half of newly qualified/registered MOs were absorbed by the public sector between 2015 and 2018. It seems timely to understand the labour market for this profession in system terms and in personal terms for doctors, especially during their labour market entry. I used a multiple-method approach including literature reviews, quantitative survey and qualitative interviews to examine doctors’ internship training experiences and labour market transition in Kenya. I found that the resources available in hospitals overall was often inadequate to support medical internship training in Kenya, especially for Level 4/district or smaller hospitals. Over half reported that their hospitals did not have enough consultants, physical resources and supplies of diagnostics, equipment and medications required for their study and work. Over half of the interns experienced burnout and anxiety, some did not have good supervision at all times and had to perform inappropriate tasks, especially in smaller hospitals. Such poor internship experiences influenced MOs’ career intentions. Some preferred to leave the public sector, however the majority still preferred to work in the public sector or continue with specialist training immediately after internship. Nonetheless, as decentralisation in 2013 led to county governments being responsible for local workforce recruitment, they are not absorbing these MOs into the public sector. This is for reasons including limited health system financing, a willingness to rely on interns to provide hospital care, and preference for recruiting other cheaper health worker cadres. These findings suggest that Kenya needs to take a strategic approach to match the demand and supply of physicians, especially at labour market entry (i.e. internship) as well as improve the internship training resources and capacity. Poor planning and management not only wastes resources and undermines healthcare delivery, but can also be detrimental to individual physicians.