薪资是否会影响非大学附属医院住院医师选择的居住地？对日本住院医师匹配计划数据的面板分析。
Does salary affect the choice of residency in non-university teaching hospitals? A panel analysis of Japan Residency Matching Programme data.
机构信息
Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
出版信息
Hum Resour Health. 2013 Mar 8;11:12. doi: 10.1186/1478-4491-11-12.
BACKGROUND
Previous studies have investigated factors that are influential on the choice of training hospitals among residency physicians, but the effect of salary was not conclusive. In this study, we aimed to examine whether a higher salary attracted more residents to non-university hospitals participating in the Japanese Residency Matching Programme.
METHODS
Data on 475 hospitals/programmes between 2006 and 2009 were available for analysis. We first conducted an ordinary least squares regression analysis on the ratio of the number of applicants to the residency programme quota as an index of resident's choice, for comparison with previous studies. We further performed panel data analysis to better control for unobserved heterogeneity across hospitals, which could be confounded by the amount of salary. We also performed stratified analysis by the population size of the hospital location.
RESULTS
In ordinary least squares regression, salary showed a positive, but not significant association, with the ratio of the number of applicants to the programme quota, while the results of a fixed effect model exhibited a positive and significant effect of salary (ε= 0.4995, P = 0.015) on the ratio. Analysis stratified by city size showed that the elasticity of salary was comparable (ε= 1.9089, P = 0.016 in large cities versus ε= 1.9185, P = 0.008 in small cities), while that of the number of teaching physicians was larger in large cities (ε= 1.9857, P = 0.009) compared with that in small cities (ε= 1.6253, P = 0.033). The number of teaching physicians had a significant and negative effect modification on salary, implying an antagonistic effect between these two attributes (ε= -1.5223, P = 0.038).
CONCLUSIONS
Our results indicate that the amount of salary influences the choice of training hospitals among medical graduates who choose non-university settings. Use of a monetary reward in a residency programme could be a feasible tactic for hospitals to attract residents.
背景
之前的研究已经调查了影响住院医师选择培训医院的因素，但薪酬的影响尚无定论。在这项研究中，我们旨在检验较高的薪酬是否会吸引更多的住院医师选择参加日本住院医师匹配计划的非大学医院。
方法
我们分析了 2006 年至 2009 年期间 475 家医院/项目的数据。我们首先对申请人与住院医师计划配额的比例进行了普通最小二乘法回归分析，作为住院医师选择的指标，与之前的研究进行了比较。我们进一步进行了面板数据分析，以更好地控制医院之间未观察到的异质性，这种异质性可能与薪酬数额有关。我们还按医院所在地的人口规模进行了分层分析。
结果
在普通最小二乘法回归中，薪酬与申请人与计划配额的比例呈正相关，但不显著，而固定效应模型的结果显示薪酬对该比例具有正显著影响（ε=0.4995，P=0.015）。按城市规模进行的分层分析表明，薪酬的弹性相当（大城市为 ε=1.9089，P=0.016，小城市为 ε=1.9185，P=0.008），而大城市的教学医师人数对薪酬的弹性更大（ε=1.9857，P=0.009）比小城市（ε=1.6253，P=0.033）。教学医师人数对薪酬有显著的负向效应修饰，表明这两个属性之间存在拮抗作用（ε=-1.5223，P=0.038）。
结论
我们的研究结果表明，薪酬水平影响着选择非大学环境的医学毕业生选择培训医院。在住院医师计划中使用金钱奖励可能是医院吸引住院医师的一种可行策略。
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