The impacts of altruism levels on the job preferences of medical students: a cross-sectional study in China

Abstract

Background Rational allocation of human resources for health is crucial for ensuring public welfare and equitable access to health services. Understanding medical students’ job preferences could help develop effective strategies for the recruitment and retention of the health workforce. Most studies explore the relationship between extrinsic incentives and job choices through discrete choice experiments (DCEs). Little attention has been paid to the influence of intrinsic altruism on job choice. This study aimed to explore the heterogeneous preferences of medical students with different levels of altruism regarding extrinsic job attributes. Methods We conducted an online survey with 925 medical students from six hospitals in Beijing from July to September 2021. The survey combined job-choice scenarios through DCEs and a simulation of a laboratory experiment on medical decision-making behavior. Behavioral data were used to quantify altruism levels by estimating altruistic parameters based on a utility function. We fit mixed logit models to estimate the effects of altruism on job preference. Results All attribute levels had the expected effect on job preferences, among which monthly income (importance weight was 30.46%, 95% CI 29.25%-31.67%) and work location (importance weight was 22.39%, 95% CI 21.14%–23.64%) were the most salient factors. The mean altruistic parameter was 0.84 (s.d. 0.19), indicating that medical students’ altruism was generally high. The subgroup analysis showed that individuals with higher altruism levels had a greater preference for non-financial incentives such as an excellent work environment, sufficient training and career development opportunities, and a light workload. The change in the rate of the uptake of a rural position by individuals with lower levels of altruism is sensitive to changes in financial incentives. Conclusions Medical students’ altruism was generally high, and those with higher altruism paid more attention to non-financial incentives. This suggests that policymakers and hospital managers should further focus on nonfinancial incentives to better motivate altruistic physicians, in addition to appropriate economic incentive when designing recruitment and retention interventions. Medical school administrations could attach importance to the promotion of altruistic values in medical education.

The substitution effect of financial and non-financial incentives at different income levels in physician recruitment: evidence from medical students in China

“…Individuals with higher altruism exhibited a higher weight attachment to patient benefits over their own financial profits. Furthermore, medical students with higher altruism paid more attention to non-financial incentives [ 24 ] (formula in Appendix Table S2). Thus, we formulated the following hypothesis:…”

“…Our experimental data stem from the DCEs combined with a lab-like experiment of Zhang et al (2023) [ 24 ] who analyzed medical students with different levels of altruism regarding extrinsic job attributes. In total, 741 medical students were integrated into the formal analysis, which were selected through cluster sampling from six teaching hospitals in Beijing, China.…”

“…The economic experiment has been demonstrated to facilitate the measurement of medical students’ altruism [ 24 , 28 ]. Specifically, a laboratory-like experiment was designed in the context of medical decision-making, all medical students took the role of physicians and determined the quantity ( q ) of medical services, thereby influencing their self-profit ( π ( q )) and patient benefit ( B ( q )).…”

“…Altruism, as an important intrinsic motivation in the principal-agent relationship between physicians and patients [ 22 ], also holds a pivotal role in physicians’ responses to incentives [ 23 ]. Zhang et al (2023) investigated the effect of intrinsic altruism on the influence of extrinsic incentives on the job preference of medical students [ 24 ]. However, the substitution effect of external incentives has not received adequate attention regarding the impact of income levels.…”

“…This study contributes to filling the gap in the evidence on the link between the substitution effect of extrinsic incentives in medical students’ job choices across different income levels, combining with the intrinsic motivations. Firstly, we estimate the substitution effect of external factors relying on the data in Zhang et al’s [ 24 ] DCEs among medical students, specifically financial and non-financial incentives, taking into account the actual design of basic income levels. Additionally, altruism measured by a lab-like economic experiment is included to examine whether it contributes to the income level and the substitution effect.…”