Using financial incentives to attract medical residents to the periphery: The Israeli experience

Abstract

BackgroundIn 2011, Israel instituted financial incentives as part of a larger program to attract doctors to residency programs in peripheral hospitals. ObjectiveTo explore the impact of these incentives and related changes on the choices of locations for residency training in Israel. MethodsWe performed (A) an analysis of administrative data on the location of all new medical residencies in 2005–2014 (B) an internet/phone survey of residents who began specialty training in 2013–2014, with a response rate of 71%. Results(A) Of all entrants to residency training programs in Israel, those in peripheral hospitals constituted 16–20% in 2005–2010, 19% in 2011, 23% in 2012, and 23% in 2013; the increase consisted predominantly of physicians who were graduates of non-Israeli medical schools (B) About half of all residents in the periphery reported that the incentives contributed to their choice of residency location. About 40% of that group also reported that they had planned already in medical school to practice in the periphery, while 60% of that group (30% of all residents in the periphery) did not have such plans prior to medical school. About 70% of the residents in peripheral hospitals grew up in the periphery; for the southern periphery this was 40% and for the northern periphery this was 80%. ConclusionsThe changes instituted in 2011 apparently affected residency location preferences for a non-negligible proportion of young physicians, particularly among those who grew up in the periphery. Policymakers should consider combining targeted incentives with measures to increase the supply of physicians who grew up in the periphery.