2011 Volume 22 Issue 2 Pages 161-178
Background：Following the implementation of a new Postgraduate Medical Education Program in April 2004, it is now up to the resident physicians to decide which hospital they would like to work. Their reluctance to work in hospitals in rural areas is one of the main factors that triggered the physician shortages in rural areas during the past five years. It is useful to investigate residents’ preferences for job characteristics and try to find a way to attract residents to medical institutions in rural areas, as few empirical studies have measured residents’ preferences quantitatively.
Objective：To clarify preferences for job characteristics and to identify the most important job attributes among resident physicians in Japan.
Methods：A postal questionnaire for a discrete choice experiment was sent to 1,227 residents at 31 hospitals. Seven job attributes were defined：daytime hours worked; presence of advising physicians; number of night shifts; opportunities to attend academic meetings; number of beds; location; and income. Respondents were asked to answer five or six questions about the choice between two medical institutions with different attributes. A random parameter logit model was estimated to represent a utility function on job attributes, and willingness to pay（WTP）for each job attribute was calculated.
Results：The response rate was 29.1% （357/1,227）. The sign was positive for three job attributes：subsidies to attend academic meetings, a location in a large city（as compared with a small or medium-sized city location）, and annual income. The sign was negative for the following five attributes; the number of daytime hours worked, absence of advising physicians, the number of night shifts, work in a clinic（rather than in a hospital）, and location in a rural area（as compared with a small or medium-sized city location）. With respect to WTP, residents on average had the highest WTP at 24.1 million yen for advising physicians. A change from a rural area to a large city represented the second-highest WTP, at 16.5 million yen.
Conclusions：The present study suggests that the presence of advising physicians and geographical conditions are extremely important factors in the residents’ choice of workplace. Restructuring medical institutions to include more advising physicians and securing access to advising physicians to institutions in rural areas will be effective in attracting residents to medical institutions in rural areas.
