Junior doctors’ specialty choice: Stated and revealed preferences over more than a decade

Abstract

An important health policy issue in many countries is the over-specialisation of the medical workforce. Understanding junior doctors’ preferences over characteristics of alternative specialties is crucial in designing policies to improve the distribution of doctors across specialties. 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 twelve years to compare their actual labour market outcomes with their estimated preferences. Our results show that stronger preferences for higher earnings are associated with choosing the specialist rather than the general practice track after five years but this effect is smaller and not statistically significant after 12 years. Non-pecuniary intrinsic attributes of specialties, specifically those reflecting the ability to use human capital abilities and skills (e.g. academic opportunities or the ability to perform procedural work) are more enduring predictors of specialty choice over the long term. While the gap in earnings between general practitioners and specialists appears to impact on choices in the short term, this may be less relevant in the long term where matching to specialties based on abilities and skills play a more persistent role.