Junior doctors' medical specialty and practice location choice: simulating policies to overcome regional inequalities.
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 predicts that an income increase of 350€ would lead to a 3 percentage point increase in choice probability, which implies an income elasticity of 3.37, a higher estimation compared to previous studies.
Medical Director Office, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil. pedrosaldanharamos@live.com.pt.|Faculty of Medicine of the University of Porto, University of Porto, Porto, Portugal. pedrosaldanharamos@live.com.pt.
Pedro
http://orcid.org/0000-0002-6825-6577
P
Ramos
Faculty of Medicine of the University of Porto, University of Porto, Porto, Portugal.
Hélio
H
Alves
Bank of Portugal, Porto, Portugal.|Faculty of Economics, University of Porto, Porto, Portugal.
Paulo
P
Guimarães
Faculty of Medicine of the University of Porto, University of Porto, Porto, Portugal.
Maria A
MA
Ferreira
D002321:Career Choice; D002755:Choice Behavior; D006801:Humans; D008511:Medicine; D012456:Salaries and Fringe Benefits; D012959:Socioeconomic Factors
Discrete choice experiment; Location decision; Medical specialty choice; Portugal; Rural uptake policies