What motivates Russian physicians to work?
Presenter: Sergey Shishkin, State University Higher School of Economics, Moscow
Rationale: Low level of public sector physicians’ labor remuneration in Russia, wide expansion of informal payments, conflict between previous professional standards and new values have formed rather specific structures of labor motivation in health sector. The latter has been not yet the subject of systematic analysis in the country. The increase of salary of primary care physicians in 2.4 times in 2006 has given the unique opportunity to assess the impact of such incentive on physicians’ labor motivation.
Objectives: The objectives of the paper are to reveal the peculiarities of physicians’ labor motivation, to typology differences in motivation structures, and to evaluate the impact of increase of primary physicians’ remuneration on their work and on motivation of other categories of physicians.
Methodology: The data for the research were gathered by qualitative interviews of 85 physicians and survey of 620 physicians conducted in 2007 in two regions of the Russian Federation: Saratov and Yaroslavl oblasts, that differ by level of economic development. The analysis of qualitative interviews data allowed to identify the set of actual significant physicians’ labor motives. The motivation structures understood as hierarchies of motives were revealed by the means of factor and cluster analysis of survey data.
Results: The activity of Russian doctors is polymotivated. The most significant motives for work are the following:
• making money;
• commitment to the profession and professional development;
• increase of social capital;
• social security;
• altruism and compassion.
Among physicians, there are significant differences in the hierarchy of motives for work. The application of factor analysis has revealed four types of physicians’ labor motivation structures:
• socio-pragmatic type of motivation: «doctors - social capitalists»; dominance motive development of social relations;
• value-oriented type of motivation: «doctors - value-oriented professionals»; dominance motives professional development and altruism;
• activity-utilitarian type of motivation: «doctors - utilitarian»; dominance motive of making money, professional development, career development;
• conservative type of motivation: «doctors-conservatives»; dominance motive of making money and job security.
Method of hierarchical cluster analysis has allowed to distinguish four fairly uniform in motivational structures groups of physicians. For almost two-thirds of doctors motivational structures are similar, and each of the three other designated groups with significant motivational differences ( «creators», «guardians profession», «climbers») covers a small part of physicians (at 12-13%). At the same time the identified clusters have statistically significant differences in claims to the level of salary and in their responsiveness to incentives.
Primary care physicians’ labor remuneration increase has been perceived by their majority as fair reconstructive rate of their labor income than as a stimulus for the development of labor productivity. This selective increase has been assessed by other categories of physicians as unfair and it has stipulated the extortion of informal payments.
Conclusions: The labor motivation of Russian physicians has saved them in the public health care sector but has made very expensive or ineffective the use of simple incentives like salary increase to stipulate them for more efficient work and to refuse from informal payments.
Authors: Sergey Shishkin, Alexander Temnitsky, Alla Chirikova
Session: Labour Issues
Time: Wed 11:15 a.m.-12:15 p.m.