Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Factors Associated with Physicians’ Choice of Working Sector

A National Longitudinal Survey in Finland

  • 43 Accesses

  • 9 Citations

Abstract

Objective

To analyse factors affecting physicians’ choice to work in either the public or the private sector.

Method

We undertook a longitudinal data analysis in the years 1988, 1993, 1998 and 2003 (n = 12 909) using a multilevel modelling technique. Factors related to economic factors, physician identity, appreciation as well as demographic factors were hypothesised to influence sector choice.

Results

Physicians seem to make their career choices prior to graduation, at least to some extent. Wage levels, the physician’s personal characteristics and whether or not the physician knew his or her place of work before graduation were the key factors affecting the decision-making process in the years 1988, 1993, 1998 and 2003. Physicians for whom wages were important were less likely to choose the public sector. Also, physicians who regarded themselves as entrepreneurial preferred to work in the private sector. If a physician had worked in the public sector during his or her medical training before graduation, the probability of applying for a vacancy in the public sector was higher.

Conclusion

It is not only economic factors, such as salary, that are involved in the physician’s decision to choose the working sector.

This is a preview of subscription content, log in to check access.

Table I
Table II
Table III

References

  1. 1

    The Finnish Medical Association [online]. Available from URL: http://www.laakariliitto.fi [Accessed 2006 Apr 26]

  2. 2

    Organisation for Economic Co-operation and Development (OECD). Health data 2004 [online]. Available from URL: http://www.oecd.org [Accessed 2006 Apr 26]

  3. 3

    Linna M, Häkkinen U, Linnakko E. An econometric study of costs of teaching and research in Finnish hospitals. Health Econ 1998; 7: 291–305

  4. 4

    Rissanen P, Häkkinen U. Priority-setting in Finnish healthcare. Health Policy 1999; 50: 143–53

  5. 5

    Blank RM. An analysis of workers’ choice between employment in the public and private sectors. Ind Labor Relat Rev 1985; 38: 211–24

  6. 6

    Davidson JM, Lambert TW, Goldacre MJ. Career pathways and destinations 18 years on among doctors who qualified in the United Kingdom in 1977: postal questionnaire survey. BMJ 1998; 317: 1425–8

  7. 7

    Leigh JP, Kravitz RL, Schembri M, et al. Physician career satisfaction across specialties. Arch Intern Med 2002; 162: 1577–84

  8. 8

    McManus IC, Winder BC, Gordon D. The causal links between stress and burnout in a longitudinal study of UK doctors. Lancet 2002; 359: 2089–90

  9. 9

    Grembowski D, Ulrich CM, Paschane D, et al. Managed care and primary physician satisfaction. J Am Board Fam Pract 2003; 16: 383–93

  10. 10

    Sibbald B, Bojke C, Gravelle H. National survey of job satisfaction and retirement intentions among general practitioners in England. BMJ 2003; 326: 1–4

  11. 11

    Clark AE. Job satisfaction and gender: why are women so happy at work? Labour Economics 1997; 4: 341–72

  12. 12

    Ferrall C, Gregory AW, Tholl W. Endogenous work hours and practice patterns of Canadian physicians. Can J Econ 1998; 31: 1–27

  13. 13

    Borjas GJ. Labor economics. Singapore: McGraw-Hill, 1996

  14. 14

    Shields MA, Ward M. Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit. J Health Econ 2001; 20: 677–701

  15. 15

    Mroz TA. The sensitivity of an empirical model of married women’s hours of work to economic and statistical assumptions. Econometrica 1987; 55: 765–99

  16. 16

    Scott A, Shiell A. Do fee descriptors influence treatment choices in general practice? A multilevel discrete choice model. J Health Econ 1997; 16: 323–42

  17. 17

    Hyppölä H. Development and evaluation of undergraduate medical education in Finland [PhD thesis]. Finland: Kuopio University Publications D. Medical Sciences, 2001: 237

  18. 18

    Vänskä J, Hyppölä H, Halila H, et al. Lääkäri 2003 (Physician 2003). Ministry of Social Affairs and Health, Publications 2005: 9 [online]. Available from URL: http://www.stm.fi [Accessed 2006 Apr 26]

  19. 19

    Hyppölä H, Kumpusalo E, Virjo I, et al. Improvement in undergraduate medical education: a 10-year follow-up in Finland. Med Teach 2002; 24: 52–6

  20. 20

    Kennedy BP, Kawachi I, Glass R, et al. Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis. BMJ 1998; 317: 917–21

  21. 21

    Isikhan V, Comez T, Danis MZ. Job stress and coping strategies in health care professionals working with cancer patients. Eur J Oncol Nurs 2004; 8: 234–44

  22. 22

    Kay LE, D’Amico F. Factors influencing satisfaction for family practice residency faculty. Fam Med 1999; 31: 409–14

  23. 23

    O’shea RM, Corah NL, Ayer WA. Sources of dentists’ stress. J Am Dent Assoc 1984; 109(1): 48–51

  24. 24

    Lazear EP. Personnel economics. Cambridge (MA): MIT Press, 1995:74–110

  25. 25

    Rice N, Jones A. Multilevel models and health economics. Health Econ 1997; 6: 561–75

  26. 26

    Hox JJ. Applied multilevel analysis. Amsterdam: TT-Publicaties, 1995

  27. 27

    Goldstein H, Rasbash J, Plewis I, et al. A user’s guide to MLwiN: Multilevel Models Project. London: Institute of Education, University of London, 1998

  28. 28

    Sturdivant RX. Goodness-of-fit in hierarchical logistic regression models: a dissertation 2004 [online]. University of Massachusetts-Amherst. Available from URL: http://www.dean.usma.edu/math/people/Sturdivant/images/Research/presentation/findefense2.ppt [Accessed 2006 Apr 26]

  29. 29

    Rodriguez G, Goldman N. Improved estimation procedures for multilevel models with binary response: a case-study. J R Statist Soc A 2001; 164: 339–55

  30. 30

    Neittaanmäki L, Gross EB, Virjo I, et al. Personal values of male and female doctors: gender aspects. Soc Sci Med 1999; 48: 559–68

Download references

Acknowledgements

The authors are grateful to two discussants and other participants in the Nordic Health Economists’ Study Group (Reykjavik, 2004) for valuable comments. Terhi Kankaanranta is grateful to The National Postgraduate School of Social and Health Policy Management and Economics for financial support.

The authors declare no conflicts of interest that would have biased this work.

Author information

Correspondence to Terhi Kankaanranta.

Appendix

Appendix

See tables AI and AII.

Table AI
figureTab4

Descriptive statistics of variables used in final models

Table AII
figureTab5

Description of independent variables used in the preliminary models

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kankaanranta, T., Vainiomäki, J., Autio, V. et al. Factors Associated with Physicians’ Choice of Working Sector. Appl Health Econ Health Policy 5, 125–136 (2006). https://doi.org/10.2165/00148365-200605020-00006

Download citation

Keywords

  • Private Sector
  • Public Sector
  • Hospital District
  • Senior Physician
  • Junior Physician