Work Hours More Important Than Money in Specialty Selection


By Keith Mulvihill

NEW YORK (Reuters Health) Feb 17 - When choosing a specialty, new physicians are more likely to base their decision on the amount of vacation time and schedule regularity than on income, new study findings show.

The results of the study suggest that efforts to increase the number of primary care physicians should consider other factors such as work schedule and vacation time, the researchers say.

"There seems to be general agreement that the US health care system has too few primary care physicians and too many specialists," lead author James Thornton, from Eastern Michigan University in Ypsilanti, told Reuters Health.

"Some have cited this as a factor contributing to high and rising medical care spending, as well as compromising the overall quality of care," he added.

But, if the objective of health care policy is to increase the number of primary care physicians and decrease the number of specialists, Thornton points out that information is needed to help understand the factors that influence specialty choice.

Together with co-author Fred Esposto, Thornton evaluated the factors that influence specialty selection for medical residents by analyzing national data published by the American Medical Association. The findings are reported in the January issue of Health Economics.

The findings indicate "that new physicians are more likely to choose specialties for which they expect to make higher future earnings, everything else [being] the same," Thornton noted.

However, earnings were not the most important factor that guided specialty choice, he added. "Annual vacation time, weekly hours worked, and regularity of work schedule have a bigger effect on specialty choice than income."

"New physicians are very attracted to specialties for which they expect to have more annual vacation time, a regular work schedule, and, for primary care specialties, fewer hours worked in a typical week," Thornton said.

If the goal is to persuade more doctors to become primary care physicians, the findings suggest that work hour incentives rather than income benefits are more likely to achieve this objective, he noted.

Thornton believes that offering work hour incentives is feasible in the current medical care system where an increasing number of physicians are no longer self-employed, but are instead affiliated with large medical organizations.

Health Econ 2003;12:61-73.