The role of monetary and nonmonetary incentives on the choice of practice establishment: a stated preference study of young physicians in Germany

Health Serv Res. 2010 Feb;45(1):212-29. doi: 10.1111/j.1475-6773.2009.01045.x. Epub 2009 Sep 24.


Introduction: The study aimed to quantify the preferences of young physicians for different attributes relevant to practice establishment in Germany.

Methods: Qualitative in-depth interviews of 22 physicians were conducted to identify relevant practice attributes. Based on this information, a questionnaire was developed containing a discrete choice experiment comprised of a "best-worst scaling" (BWS) task. It was mailed to a representative sample of 14,939 young physicians who were close to making a decision regarding practice establishment. Regression analysis was used to estimate utility weights quantifying physicians' preferences for practice attributes.

Results: Qualitative interviews identified six attributes: "professional cooperation,""income,""career opportunities of the partner,""availability of child care,""leisure activities," and "on-call duties." For the BWS task, 5,026 returned questionnaires were analyzed. Results indicated that a change in income led to the largest utility change compared with changes in other attributes. Additional net income to compensate the disutility of a rural practice as compared with an urban practice was 9,044euro/months (U.S.$ 11,938). Yet, nonmonetary attributes such as on-site availability of childcare and fewer on-call duties would decrease the additional income required to compensate the disutility of a rural practice.

Discussion: The results offer quantifiable information about young physicians' preferences in establishing a practice. It can assist health policy makers in developing tailored incentive-based interventions addressing urban-rural inequalities in physician coverage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Choice Behavior*
  • Female
  • Germany
  • Humans
  • Interviews as Topic
  • Male
  • Motivation*
  • Physicians / psychology*
  • Physicians / supply & distribution
  • Practice Management, Medical*
  • Surveys and Questionnaires