Exploring long-term retention intention and influencing factors among rural-oriented medical students in primary care in Guangxi, China: a qualitative study

Retaining qualified health professionals in remote rural areas remains a persistent global challenge. China’s rural-oriented medical students programme(ROMSP) was established to address shortages of health professionals in township health centres. However, emerging evidence suggests considerable turnover intention among participants after completion of their mandatory service period This study aimed to explore long-term retention intentions and the factors influencing retention among rural-oriented medical students working in primary care in Guangxi, China. This exploratory qualitative study conducted semi-structured interviews with 26 rural-oriented medical students who had worked in their designated township health centres for between one and three years. The interview guide was developed based on a multidimensional framework of person–environment fit theory. Thematic analysis was used to code, analyse, and interpret the findings according to the theory’s five dimensions. Long-term retention intentions among rural-oriented medical students in Guangxi appeared limited, with only 23.1% (6/26) of participants expressing willingness to remain in their positions beyond the mandatory service period. Guided by the five dimensions of person–environment fit theory, leadership support within person–person fit emerged as a prominent factor associated with differences between participants intending to stay and those intending to leave. The person–job fit encompassed the broadest range of factors, with work–family balance identified as a facilitator. The influence of person–vocation fit was reflected through its interactions with other dimensions, whereas person–organisation fit and person–group fit appeared to play comparatively smaller roles. To enhance long-term retention among rural-oriented medical students in primary care, interventions should focus on strengthening leadership capacity among township health centre directors, promoting work–family balance, and improving career mobility mechanisms after the mandatory service period. This study provides empirical support for applying person–environment fit theory to contract-based health workforce programmes and offers transferable insights for other countries facing similar rural health workforce challenges.