Getting doctors into the bush: General Practitioners' preferences for rural location

Abstract

A key policy issue in many countries is the maldistribution of doctors across geographic areas, which has important effects on equity of access and health care costs. Many government programs and incentive schemes have been established to encourage doctors to practise in rural areas. However, there is little robust evidence of the effectiveness of such incentive schemes. The aim of this study is to examine the preferences of general practitioners (GPs) for rural location using a discrete choice experiment. This is used to estimate the probabilities of moving to a rural area, and the size of financial incentives GPs would require to move there. GPs were asked to choose between two job options or to stay at their current job as part of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. 3727 GPs completed the experiment. Sixty five per cent of GPs chose to stay where they were in all choices presented to them. Moving to an inland town with less than 5000 population and reasonable levels of other job characteristics would require incentives equivalent to 64% of current average annual personal earnings ($116,000). Moving to a town with a population between 5000 and 20,000 people would require incentives of at least 37% of current annual earnings, around $68,000. The size of incentives depends not only on the area but also on the characteristics of the job. The least attractive rural job package would require incentives of at least 130% of annual earnings, around $237,000. It is important to begin to tailor incentive packages to the characteristics of jobs and of rural areas.

Factors Affecting the Service Delivery Locations of Newly Graduated Iranian General Practitioners

“…For instance, Matsumoto et al identified commercial land price in a region as a factor (34); Ricketts and Randolph as well as Kassak et al identified the factor of urban development (35,38), and Isabel and Paula identified income geography (33) as significant factors. Other studies have similar findings, indicating that service location status and level of development are affecting factors (6,8,19,39,40,48).…”

“…2017; 19(2):e40032. include quality of life in the service location (37); the gender, university of medical study, and local residency of the GP (native); the number of healthcare visits per week and the average time spent per visit; the GPs' income, schedule, and working hours; and educational and promotion opportunities (8,19,20,36,38,41,43).…”

“…Rather, the imbalanced distribution of physicians and their focus in urban areas, together with their shortage in rural areas, has been considered a political problem worldwide for some time (5)(6)(7)(8)(9)(10)(11). According to the world health organization (WHO) in 2006, 57 countries around the world faced healthcare workforce crises involving the distribution of physicians, nurses, and midwives across different regions (8,12). Also, in the United States, the physician to population ratio can vary up to two times for different states.…”

“…Some factors affecting the mal-distribution of physicians over geographical regions worldwide can increase the attractiveness of certain areas for GPs. Among these, economic and social factors are the most important (8,(16)(17)(18). According to Katz et al, relevant factors include physicians' age, gender, and efficiency; the demand for health services; location; and payment system (19).…”

“…Identified factors in other studies include the following: the gender, university of medical study, ethnic origin, language, income level, and resources of the GP; the type (urban or rural), location, and/or geographic status of the region; the weekly average of patient visits, including the average time spent per visit; job characteristics and workload, including daily working hours; opportunities for education and promotion; the variety of skilled specialists in the region and specialty orientation; and, finally, organizational factors (8,10,14,20,(38)(39)(40)(41)(42). According to Pedersen et al not only do self-employed physicians have different preferences compared to recruited peers in organizations, but also factors such as workload, physician age, and working hours affect the tendency to work in different regions (43).…”