Determinants of physicians' decisions to specialize (original) (raw)
Related papers
Does educational indebtedness affect physician specialty choice?
Journal of Health Economics, 1985
There has been much debate over the effect of educational indebtedness on ihe specialty choices of new physicians, especially in light of the perceived shortage of primary care physicians. This paper explores the theoretical foundations on which this debate is based. In addition, the paper estimates the effects of various types of debt on specialty choice. The results suggest that an increase in debt from subsidized loan sources (i.e., Guaranteed Student Loans, National Direct Student Loans, or Health Professions Student Loans) has mixed effects while an increase in debt from Health Education Assistance Loans reduces the likelihood of becoming a primary care physician. Though these effects are significant, they are very small in magnitude. Economic returns to certain specialties and personal background appear to play a more important role in specialty choice.
Cost Effectiveness and Resource Allocation, 2022
Background: Choosing a specialty by physicians is fundamentally linked to the performance of health systems and public health outcomes. Identifying the determinants of specialty selection is important to health policy for targeting resources and planning the development of services. This study examined preferences of Iranian physicians for medical specialty using a discrete choice experiment (DCE) method. Methods: In this study, the attributes of the DCE were determined using rigorous qualitative approach. Then we applied D-efficiency criteria to design the DCE and validated it at a pilot study. In the final survey, we recruited participants from six Iranian provinces and analyzed data using conditional logit model. We estimated willingness to pay (WTP) for non-monetary attributes. Results: The WTP analysis revealed that the most important non-monetary attributes in the selection of a specialty were job burnout, opportunity for procedural activities, and job prestige. The results imply that the attributes that were related to the quality of personal life was more important only for physicians who preferred to choose nonsurgical specialties. Conclusions: The findings demonstrate that traditional gender patterns of specialty selection are changing and quality of personal life characteristics might be the most important factor when developing policies to recruit physicians into non-surgical specialties.
A macro model of change in specialty and spatial distribution of physicians in Canada, 1971–1981
Socio-economic Planning Sciences, 1992
Most studies on physician distribution have examined static relationships involving the influence of such factors as socioeconomic status. This study employs a causal model to study change in physician ratios (general practitioners and family physicians, and specialists) between 1971 and I981 as a function of change in hospital bed ratios, population size, age distribution, educational attainment of the population, population "native", owner-occupied dwellings, and geographic proximity to the nearest metropolitan area, using physician data for I89 Canadian census divisions. The results, derived from LISREL VI analyses, indicate that specialists experienced increases in their supply in higher socioeconomic status areas and in those areas losing general practitioners and family physicians (from 1971 to 1981). General practitioners and family physicians appear to have moved into areas with a relatively low percentage of owner-occupied dwellings and areas where a large percentage of the population is "native". Both groups of physicians appear to have increased in areas where there were increases in hospital facilities over the decade. The study confirms the known association between the two physician groups; that is, general practitioners and family physicians increased in areas gaining specialists and specialists increased in areas where considerable decreases in general practitioners and family physicians were occurring. Findings are discussed in terms of implications for physician manpower planning.
Medical specialty choice: a dilemma between dream and necessity
Brazilian Journal of Clinical Medicine and Review, 2024
The definition of a medical specialty is important both for the student's future professional career as well as for the diversity of specialties and the number of professionals that will make up a given health system. Identify the areas of activity preferred by medical school specialists and compare them with government needs. Methods: A multicenter study with a cross-sectional, quantitative approach. The sample was made up of 201 finalists. Data were collected through a closed questionnaire automatically generated by Google Forms and exported to the statistical program (SPSS26) to calculate absolute and relative frequencies. The three specialties preferred by the finalists were Gynecology/Obstetrics (18.8%), Pediatrics (15.6%) and General Surgery (13.3%); the factors that led them to choose their specialties were affinity for the specialty (32.8%) and admiration for a teacher (19.5%). Comparing these results with the state's needs, we found that student preferences were directed toward priority specialties at the tertiary level. It was observed that the most commonly chosen specialty was Gynecology/Obstetrics; the determining factor was affinity for the specialty and in comparison, with what the government needs, students' preferences were directed toward priority specialties at the tertiary level and in the hospital branch.
Reconsidering Theories and Models of Specialty Preference: A Critical Review
2018
Background: Choosing medical specialties by physicians is important in workforce planning of health care services; yet there is not enough theoretic understanding about how medical specialties are chosen. So the key concepts of nine theories have been the basis of the present study. Methods: In this study the Critical Review methodology, Carnwell and Daly structures and the three steps proposed by Schutz were used. Results: While we criticize the work of each theorist with a casual sequence of effective factors on the chosen career in each theory, we have tried to design a comprehensive Meta model for specialty choice by investigating and synthesizing available theories. Conclusion: This model has remarkable advantages to other presented models and related context to explain factors affecting career choice. Since it includes all elements concerning career choice, it can be used as the basic tool to identify professional interests, help choose a career effectively and provide critical information for policy-makers for the effective management of physician workforce in different specialties and different regions in the country.
Financial incentives for physicians: The Quebec experience
Health Economics, 1993
This paper presents an empirical investigation of physician labour supply, based on a two-stage budgeting model, drawing on an analogy with consumer theory. Physicians' trade-offs between income and leisure constitute the first stage of the decision-making process. In turn, choices are made in the second stage concerning the choice of particular activities (hospital versus office care, for example) or procedures (ordinary versus complete medical examinations), given the total medical care activity chosen in the first stage. The objective of the study is to identify physicians' responses to exogenous shocks in the remuneration system. The focus of analysis is shifted away from the identification of Supply-Induced Demand (SID) to a more pragmatic analysis of some of the determinants of physicians' choices. The study uses monthly activity data on a panel of 677 QuCbec GPs between 1977 and 1983. Quantity adjustments and drifts to more complex (and therefore better paid) procedures are evidenced, mainly in response to a fifteen month tariff-freeze. Physicians' ability to control their own work loads is also documented, both in terms of timing and level of complexity, and expenditure caps (in the form of an individual ceiling on GPs' quarterly gross income) are found to be effective at curbing high activity rates.
The European journal of health economics : HEPAC : health economics in prevention and care, 2016
There are nowadays over 1 million Portuguese who lack a primary care physician. By applying a discrete choice experiment to a large representative sample of Portuguese junior doctors (N = 503) in 2014, we provide an indication that this shortage may be addressed with a careful policy design that mixes pecuniary and non-pecuniary incentives for these junior physicians. According to our simulations, a policy that includes such incentives may increase uptake of general practitioners (GPs) in rural areas from 18% to 30%. Marginal wages estimated from our model are realistic and close to market prices: an extra hour of work would require an hourly wage of 16.5€; moving to an inland rural setting would involve an increase in monthly income of 1.150€ (almost doubling residents' current income); a shift to a GP career would imply an 849€ increase in monthly income. Additional opportunities to work outside the National Health Service overcome an income reduction of 433€. Our simulation p...
A study of career choice patterns among Canadian medical students
American Journal of Surgery, 2003
The number of students pursuing general surgery (GS) has declined in Canada. The reasons for this, and program directors' (PDs) perception of it, are unclear. Methods: A survey was distributed to medical students at Queen's University and the University of Manitoba, and to all Canadian GS program directors to explore causes for the trend and identify potential solutions. Results: Students pursuing GS were more likely to feel that GS fit their lifestyle needs (P Ͻ 0.05) and to have met positive role models (P Ͻ 0.05). Hardship of the training and practice, length of training, need for prestige, income and enjoyment of procedures did not correlate with specialty choice. Half of GS PDs did not perceive a decline in the number of applicants. Conclusions: Attention to student-raised concerns regarding GS programs and increased awareness of the applicants' trends among PDs can be used to address the current decline in applications to GS.
Full medical program fees and medical student career intention
The Medical journal of Australia, 2015
To explore the future career preferences of Commonwealth-supported place (CSP) and full-fee paying (FFP) medical students in Australia. Data from the Medical Schools Outcomes Database and Longitudinal Tracking (MSOD) Project exit questionnaire for CSP and FFP students who graduated between 2008 and 2011 were analysed using logistic regression. The influence of age, sex, marital status, rural background and fee-paying status on future career preference were explored. Future career preference (location and specialty) at graduation. Compared with CSP students, domestic FFP students were more likely to nominate as their first preference both urban locations (odds ratio [OR], 5.58; 95% CI, 2.04-15.26; P < 0.001) and higher-income specialties (OR, 1.37; 95% CI, 1.07-1.75; P < 0.05), and less likely to nominate as their first preference in-need specialties (OR, 0.72; 95% CI, 0.52-1.00; P < 0.05), specifically general practice (OR, 0.71; 95% CI, 0.52-0.99; P < 0.05). There was a...