Job preferences for medical and nursing students to work in rural Guizhou Province, China: a discrete choice experiment

Abstract

Background Maldistribution of health workers between urban and rural areas has been a critical difficulty in China. The shortage of health workers in disadvantaged areas reduces access to essential health services delivery, and adversely affects the population health. Policies on attracting health workers to locate in rural areas are needed to be explored. In order to identify the appropriate incentives, we conducted a discrete choice experiment to determine how specific job attributes might be valued by final year students in medical university in Guizhou Province, China. Methods Attributes of potential job were developed through literature review, in-depth semi-structured interviews and pretest. Salary, education opportunity, transportation, job location, workload, essential equipment, medical order, and identification ('bianzhi') were included. The questionnaire was formulated through a fractional factorial experiment design using %MktRuns macros of SAS 9.4. All medical and nursing students in the final year at Guizhou Medical University were invited to participate in the study. Mixed logit model was used to estimate stated preferences of attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates. Results The final sample comprised 787 respondents, including 388 medical students and 399 nursing students. Attributes were statistically significant (with the exception of once every two years for education opportunity) and had expected signs. The results indicate that physical conflict between doctors and patients and identification ('bianzhi') were two of the most important non-monetary job characteristics for both medical and nursing students. And nursing students placed more value on identification ('bianzhi'). Policy simulation suggests that as for the individual incentive respondents were most sensitive to salary increasing. Incentive packages effects were stronger for students from rural background. Conclusions Strategies on medical order, identification ('bianzhi') and salary should be considered to attract final year medical and nursing students to work in rural areas. In addition, specific recruitment policy design tailored for subgroups should be taken into account.