The Role of Monetary and Nonmonetary Incentives on the Choice of Practice Establishment: A Stated Preference Study of Young Physicians in Germany

Abstract

Introduction. The study aimed to quantify the preferences of young physicians for different attributes relevant to practice establishment in Germany. Methods. Qualitative in‐depth interviews of 22 physicians were conducted to identify relevant practice attributes. Based on this information, a questionnaire was developed containing a discrete choice experiment comprised of a “best–worst scaling” (BWS) task. It was mailed to a representative sample of 14,939 young physicians who were close to making a decision regarding practice establishment. Regression analysis was used to estimate utility weights quantifying physicians' preferences for practice attributes. Results. Qualitative interviews identified six attributes: “professional cooperation,”“income,”“career opportunities of the partner,”“availability of child care,”“leisure activities,” and “on‐call duties.” For the BWS task, 5,026 returned questionnaires were analyzed. Results indicated that a change in income led to the largest utility change compared with changes in other attributes. Additional net income to compensate the disutility of a rural practice as compared with an urban practice was 9,044€/months (U.S.$ 11,938). Yet, nonmonetary attributes such as on‐site availability of childcare and fewer on‐call duties would decrease the additional income required to compensate the disutility of a rural practice. Discussion. The results offer quantifiable information about young physicians' preferences in establishing a practice. It can assist health policy makers in developing tailored incentive‐based interventions addressing urban–rural inequalities in physician coverage.

Regional distribution of physicians: the role of comprehensive private health insurance in Germany

“…An interrelated possible cause of the negative income elasticity is that higher SHI income outside urban centres is not able to offset the disutility of leaving the city. This explanation is to some extent supported by Günther et al [21], who found that the additional net income required to compensate the disutility of a rural compared to a urban practice is €9044 per month (€108,528 per year) for young German physicians.…”

“…In addition, conditions of employment including workload, call schedules [14] and the financial stability of the practice [15] are found to impact upon location choice. Most health economics studies are concerned with either the impact of marginal changes in income and/or the level of income on location choice [16] or with eliciting preferences regarding financial compensation for practicing in a rural setting [17][18][19][20][21]. A small number of studies have investigated the role of the private sector in the regional variation of physicians: Gächter et al [22] analysed how the co-existence of public and private health care providers impacts upon regional densities in Austria.…”

Weiterbildungsziel und Niederlassungsentscheidung bei zukünftigen Fachärztinnen und Fachärzten in Deutschland

“…Interessant ist in diesem Zusammenhang, dass die ambulante ärztliche Versorgung in den alten Bundesländern eine klassische Männer-domäne war -und mit mehr als 60% niedergelassenen Medizinern weiterhin ist [2,5]. Auf eine ähnliche Tendenz verweisen die Ergebnisse von Günther und Mitarbeiter: Die Analyse von Anreizen für die Niederlassung von Ärzten und Ärztinnen ergab, dass für die Subgruppe der ledigen männlichen Assistenzärzte ohne Kinder die Höhe des monatlichen Einkommens für eine Niederlassungsentscheidung besonders wichtig war [23].…”

Junior doctors’ preferences for specialty choice

“…Scott, 2001;Ubach et al, 2003) or rural/urban location issues (e.g. Kolstad, 2011;Gunther et al, 2011). This paper is the first discrete choice experiment analysing the specialty choice of junior doctors, a group whose preferences are arguably the most important for the future of the health workforce.…”