Junior doctors' medical specialty and practice location choice: simulating policies to overcome regional inequalities

Abstract

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 16.5a,notsign; moving to an inland rural setting would involve an increase in monthly income of 1.150a,notsign (almost doubling residents' current income); a shift to a GP career would imply an 849a,notsign increase in monthly income. Additional opportunities to work outside the National Health Service overcome an income reduction of 433a,notsign. Our simulation predicts that an income increase of 350a,notsign 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.