Remuneration and organization in general practice: Three essays on doctors' preferences

Abstract

The need for recruiting and retaining general practitioners (GPs) is expected to increase substantially in the next years, both because of an ageing population and a reform suggesting to shift more resources to primary care. This will not only reinforce the current challenge of recruitment and retention in rural areas, but it may also make it more difficult to recruit and retain GPs in urban areas. The evidence for the effectiveness of various incentives schemes, which can be specifically implemented to boost recruitment to general practice, is generally considered to be poor. The overarching objective of this thesis is to improve the current understanding of what policy makers could do to boost recruitment and retention of GPs. More specifically, this thesis aims to identify doctors’ preferences for various pecuniary and non-pecuniary job characteristics. Structured questionnaires, including discrete choice experiments (DCEs), were used to collect data from young doctors (i.e. medical students and interns in 2010) and GPs (those registered in the HELFO database in 2012). The results suggest that joint policy programs containing several non-pecuniary incentives (e.g. improved opportunity for professional development and control over working hours), could contribute to solve the current issue of getting doctors to rural areas. Increased income, from the current levels in Norway, appears to have limited effects. This is because doctors’ value income increases beyond a reference level, which has already been achieved, to a limited extent. Furthermore, the results suggest that an increasing proportion of doctors would prefer salaried contracts rather than private practice (i.e. the current default contract for GPs). This applies particularly among younger female doctors.