Kiker B F, Zeh M
Department of Economics, University of South Carolina, Columbia, USA.
J Health Soc Behav. 1998 Jun;39(2):152-67.
We analyze the effects of relative income expectations, expected malpractice premium cost, and other economic and noneconomic factors on physician specialty choice. The data for this paper are taken from responses of medical students who completed the Association of American Medical Colleges' Medical School Questionnaire and graduated from medical school in 1995. A random utility model is used to guide our thinking; the econometric technique is multinomial logit regression. Selection of a surgical or support specialty is found to be positively income motivated, while the influence of expected relative income is negatively related to the choice of primary-care and medical practices. Concern over malpractice premium cost is negatively related to surgical and positively related to primary-care selection. Other important determinants of choice are planned location of practice, length of residency, type of medical school attended, score on the science problems section of the Medical College Admission Test, predictable working hours and perceived prestige of the specialty. Policies that alter expected relative income, length of residency, desired location of practice, medical school attended, predictable working hours, and prestige of practice, rather than financial aid, may be appropriate for correcting a perceived maldistribution of physicians among specialties.
我们分析了相对收入预期、预期医疗事故保险费用以及其他经济和非经济因素对医生专业选择的影响。本文的数据取自完成了美国医学院协会医学院调查问卷并于1995年从医学院毕业的医学生的回答。我们使用随机效用模型来指导我们的思考；计量经济学技术是多项逻辑回归。研究发现，选择外科或辅助专业受到收入的正向激励，而预期相对收入的影响与初级保健和医疗实践的选择呈负相关。对医疗事故保险费用的担忧与外科专业选择呈负相关，与初级保健专业选择呈正相关。其他重要的选择决定因素包括计划执业地点、住院医师培训时长、就读医学院类型、医学院入学考试科学问题部分的分数、可预测的工作时间以及该专业的感知声望。改变预期相对收入、住院医师培训时长、期望的执业地点、就读医学院、可预测的工作时间以及执业声望的政策，而非经济援助，可能适合于纠正各专业间医生分布不均的问题。
