Junior doctors' specialty choice: Stated and revealed preferences of over 10 years

Abstract: An important health policy issue in many countries is the over-specialisation of the medical workforce. In the US, UK and Australia the proportion of doctors practising as specialists has increased markedly over the past three decades, often resulting in a shortage of general practitioners. Understanding junior doctors’ preferences over characteristics of alternative specialties is crucial in designing policies to influence the medical workforce. This paper estimates individual-level preferences over characteristics of alternative specialties from a stated-preference discrete-choice experiment (DCE) of junior doctors, then follows up the junior doctors from the DCE over the following decade to compare their actual labour market outcomes with their estimated preferences.

Our results show that preferences for higher earnings are associated with choosing the specialist rather than the GP track after five years but this effect is smaller and not statistically significant after 10 years. We document the drivers of this result, showing that a group of doctors with particularly high earnings preferences are in the “specialist” group after five years, but are in the “GP” group after 10 years. These results are valuable in designing policies to affect the distribution of junior doctors between general and specialist medical careers. In particular, the results show that while the gap in earnings between GPs and specialists appears to impact on choices over the short-term, over the long-term these may be less significant than qualitative attributes of specialist practice compared to those of general practice.