Preferences for job characteristics among hospital physicians in Japan

Presenter: Hiroshi Sano, Institute for Health Economics and Policy

Abstract

Background: The maldistribution of physicians is a serious problem in Japan. It is useful to investigate physicians’ preferences for job characteristics to solve this problem, but there are few empirical studies for measuring physicians’ preference quantitatively.
Objective: To identify potential job characteristics for the workplace shift of hospital physicians.
Methods: A postal questionnaire including a discrete choice experiment was sent to 2,436 physicians of 27 hospitals. Seven important attributes of hospital job characteristics were defined (daytime hours worked, existence of consultable physician, out of hours work, opportunities to academic meetings, number of beds, location and income), Respondents were asked to eight or nine questions about whether they would choose ”Hospital A or B”. Random effect probit model was used to estimate utilities for job attributes. Willingness to pay and willingness to accept for a change in each job characteristics were calculated. Heterogeneity of preferences were also considered using random parameter logit model.
Results: The response rate was 30.0% (731/ 2,436). 78.2% of respondents were male, with the average age of 38 years old. Most respondents were working at large hospitals in urban areas. By examining the physicians’ preference for job characteristics, we found five main points. First, high salary elevated physicians’ utility and the increase in working hours decreased it. Second, physicians tended to most avoid working in remote areas. They need to be compensated up to $52,300 (45% of their average pre-tax income) for working in hospitals in remote areas, Third, compensation of up to $47,200 if they don’t have colleagues within their practice to confide in. Forth, they would be willing to accept $32,100 to forgo the opportunities for academic meetings. Finally, heterogeneity of WTP/WTA was observed according to age, gender and specialties.
Conclusions: The results suggested that physicians’ choice of job characteristics was influenced by not only their salary but also non-pecuniary attributes, particularly locations, availability of clinical support from other specialists, and opportunities to develop medical knowledge and skills. In addition to dispatching physicians to remote areas, improving the support systems , in which they are assured to have advices from other physicians and opportunities to attend academic meetings, will be effective in addressing the maldistribution of physicians in Japan.