title: Allocation of Residency Training Positions in Spain: Contextual Effects on Specialty Preferences.
abstract: In Spain's 'MIR' system, medical school graduates are ranked by their performance on a national exam and then sequentially choose from the available residency training positions. We took advantage of a unique survey of participants in the 2012 annual MIR cycle to analyze preferences under two different choice scenarios: the residency program actually chosen by each participant when it came her turn (the 'real') and the program that she would have chosen if all residency training programs had been available (the 'counterfactual'). Utilizing conditional logit models with random coefficients, we found significant differences in medical graduates' preferences between the two scenarios, particularly with respect to three specialty attributes: work hours/lifestyle, prestige among colleagues, and annual remuneration. In the counterfactual world, these attributes were valued preferentially by those nearer to the top, while in the real world, they were valued preferentially by graduates nearer to the bottom of the national ranking. Medical graduates' specialty preferences, which we conclude, are not intrinsically stable but depend critically on the 'rules of the game'. The MIR assignment system, by restricting choice, effectively creates an externality in which those at the bottom, who have fewer choices, want what those at the top already have. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Harris
authors.affiliation: Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
authors.forename: Beatriz G
authors.initials: BG
authors.lastname: Lopez-Valcarcel
authors.affiliation: Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Barber
authors.affiliation: Faculty of Economic and Business Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Ortún
mesh_terms: D002321:Career Choice; D002755:Choice Behavior; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008511:Medicine; D010820:Physicians / Q000191:economics; D013030:Spain; D011795:Surveys and Questionnaires
keywords: MIR system; independence of irrelevant alternatives; medical residency; mixed logit; physician income; professional prestige