Why Junior Doctors Don’t Want to Become General Practitioners: A Discrete Choice Experiment from the MABEL Longitudinal Study of Doctors

Abstract

A number of studies suggest there is an over-supply of specialists and an under-supply of GPs in many developed countries. Previous econometric studies of specialty choice from the US suggest that a number of factors play a role, including expected future earnings, educational debt, and having predictable working hours. Given endogeneity issues in revealed preference studies, a stated-preference approach is warranted. This paper presents results from a discrete-choice experiment completed by a sample of 532 junior doctors in 2008 before they choose a specialty training program. This was conducted as part of the first wave of the MABEL (Medicine in Australia: Balancing Employment and Life) longitudinal survey of doctors. We include key job attributes such as future earnings and hours worked, but also allow the choice to be influenced by academic research opportunities, continuity of care and the amount of procedural work. Interactions of attributes with doctor characteristics, including gender, educational debt, and personality traits are also examined. We find the income/working hours trade-offs estimated from our discrete choice model are close to the actual wages of senior specialists, but much higher than those of senior GPs. In a policy simulation we find that increasing GPs’ earnings by $50,000, increasing opportunities for procedural or academic work can increase the number of junior doctors choosing General Practice by between 8 and 16 percentage points, approximately 212 to 376 junior doctors per year. The results can inform policymakers looking to address unbalanced supply of doctors across specialties.