Determinants of Medical Employment in Urban Mexico: Ascription, Achievement and Context

Abstract

This study examines unemployment and underemployment of physicians in urban Mexico. The framework is relevant to countries with substantial increases in physician supply. Based on surveys from 1986 and 1993, the study analyses physician performance in the labour market as a function of ascription (social origin and gender), achievement (quality of medical education and specialization) and contextual variables (policy environments). By comparing two points in time, the article examines the impact of policies. The study reveals persistently high open unemployment, qualitative underemployment (that is, working outside medicine) and quantitative underemployment (that is, working in medical activities but with low productivity and remuneration). Improvements over time can be in part attributed to policies to control the supply of physicians. The growing proportion of female doctors presents challenges, since they are more likely to be unemployed or underemployed. The article concludes that health systems must strive to reduce the perverse effects of unbalanced labour markets in order to avoid reproducing rather than correcting social inequalities. Corrective policies regarding physician supply can be effective. The professional opportunities available to female doctors deserve attention.