Using financial incentives to attract medical residents to the periphery: The Israeli experience

Ashkenazi, Yael; Gordon, Michal; Rosen, Bruce

doi:10.1016/j.healthpol.2018.10.006

Cited by 15 publications

(16 citation statements)

References 18 publications

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“…Other studies showed that a joint decision is especially common in two-career families [ 9 ]. In contrast, the students reported that choosing a residency program includes family influence, especially as it relates to the location of their family’s residence, an observation that has similarly been made by other investigators [ 10 ]. In the present study family influence and location were more important for female than male students.…”

Section: Discussionmentioning

confidence: 76%

“…Many had already changed their choices. Ashkenazi et al [ 10 ] found that 74% of Israeli medical school graduates had decided on their specialty during their clinical years at medical school or during their internship. Therefore, the 5th year appears to be an opportune time for medical schools to begin career counseling and for department chairs and residency program directors to start marketing their specialties and residency programs [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups

Avidan

Weissman

Elchalal

et al. 2018

Isr J Health Policy Res

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BackgroundIsraeli medical school classes include a number of student subgroups. Therefore, interventions aimed at recruiting medical students to the various specialties should to be tailored to each subgroup.MethodsQuestionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University – Hadassah School of Medicine, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and the importance of finding a specialty interesting and challenging when choosing a residency.ResultsCompleted questionnaires were returned by 540 of 769 (70%) students. The decision processes for choosing a medical specialty and choosing a residency program were different. Family and colleagues had minimal influence on choosing a specialty, while family and their residential locality had much influence on choosing a residency, especially among women. Older age, marriage, and spousal influence were positively associated with choice of a specialty. Two-thirds of the students had completed military service, 20% were attending medical school prior to military service, 5% had completed national service and 9% had entered medical school without serving. Despite the pre-military subgroup being younger and having another 7 years of medical school, internship and military service before residency, they had begun thinking about which specialty to choose, just like the post-military students. When choosing a residency program, post-military women were more influenced by their families and family residential locality than their pre-military counterparts; differences ascribed to the older and often married post-military women having or wanting to begin families. This difference was reinforced by fewer post- than pre-military women willing to wait 2-3 years for a residency in the specialty that interested them most and were willing to begin residency immediately after internship in a specialty that interested them less.ConclusionsMedical school classes are composed of various subgroups, each with its own characteristics. It is important to differentiate between choosing a specialty and a residency program. Choosing a specialty is a uniquely personal decision with some spousal influence among married students. It is of central importance even among pre-military students not slated to begin residency for many years. In contrast, choosing a residency program is influenced by family, where one grew up and other family-related considerations.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups

Avidan

Weissman

Elchalal

et al. 2018

Isr J Health Policy Res

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“…A recent study of Israeli family medicine residents reported similar findings. Specifically, more than 85% of residents reported that factors that positively influence their choice included the ability to combine work, family, and free time; direct, meaningful contact with patients; the diversity of patients and medical conditions; and attractive working conditions [ 23 ]. This interest profile is similar to those reported from other countries among students interested in primary care and family medicine [ 12 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…The challenge is to better characterize this student group, identify them early during their specialty/residency program decision process and provide positive information and counseling about residency programs and lifestyle in the periphery. Thirty percent of the residents working in Israel’s periphery reported that the incentives had influenced them greatly, even though initially they had intended to work there [ 23 ]. Previous studies have shown that Israeli primary care practitioners in the periphery are more satisfied and had a broader scope of practice than urban practitioners [ 29 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another limitation is that the study only included Israeli medical students when half the medical internship workforce is comprised of Israeli who graduated from foreign medical schools and immigrants and 58% of the family medicine residents graduated from such schools [ 23 ]. Yet, unlike the foreign graduates who only enter the Israeli healthcare system as interns, having had exposure to the various specialties in foreign healthcare systems during medical school, the Israeli medical students are part of the Israeli healthcare system while they are medical students providing the Israeli healthcare leadership the opportunity to directly expose them to Israeli primary and rural practices early in their clinical experience.…”

Section: Discussionmentioning

confidence: 99%

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Challenges to the Israeli healthcare system: attracting medical students to primary care and to the periphery

Weissman

Zisk-Rony

Avidan

et al. 2018

Isr J Health Policy Res

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BackgroundThe greatest challenges facing healthcare systems include ensuring a sufficient supply of primary care physicians and physicians willing to work in rural or peripheral areas. Especially challenging is enticing young physicians to practice primary care in rural/peripheral areas. Identifying medical students interested in primary care and in residencies in Israel’s periphery should aid the healthcare leadership. It may be particularly important to do so during the clinical years, as this is the stage at which many future physicians begin to crystallize their specialty and location preferences.MethodsQuestionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University – Hadassah School of Medicine, from 2010 to 2016, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and whether one-time monetary grants authorized in the 2011 physicians’ union contract would attract students to residencies in the periphery.ResultsCompleted questionnaires were returned by 511 of 740 (69%) students. Ninety-eight (19%) were interested in a primary care residency, 184 (36%) were unsure and 229 (45%) were not interested. Students interested in primary care were significantly less interested in specialties that perform procedures/surgeries and in joining a medical school faculty, while being more inclined towards specialties dealing with social problems, controllable lifestyles and working limited hours. The percentage of students interested in primary care was stable during the study period.Forty-eight of the students indicated interest in residencies in the country’s periphery, and 42% of them were also interested in primary care residencies. Overall, only 3.7% of students were interested in both a primary care residency and a residency in the periphery.Thirty percent of the students indicated that the monetary incentives tempted them to consider a residency in the periphery. Fifty-three percent of these students reported that they did not yet know the geographic area where they wished to do their residency, as compared to only 22% among those not interested in incentives.ConclusionsThis study provides the healthcare leadership with information on the characteristics of the students at a centrally-located medical school who tend to be more interested in primary care and in working in the periphery. Specifically, the study found that students interested in primary care desire a positive life/work balance, something that Israeli non-hospital primary care practice provides. Students considering residencies in the periphery were similarly inclined. Moreover, about a third of students had positive thoughts about monetary incentives for residencies in peripheral hospitals. These students should be identified early during their clinical experience so that attempts to recruit them to the periphery can commence before their specialty and location preferences have fully crystallized. Parallel studies should be performed at additional Israeli medical schools.

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Humanitarian Relief Sustainability: A Framework of Humanitarian Logistics Digital Business Ecosystem

Baffoe

Luo

2020

Transportation Research Procedia

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Using financial incentives to attract medical residents to the periphery: The Israeli experience

Cited by 15 publications

References 18 publications

Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups

Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups

Challenges to the Israeli healthcare system: attracting medical students to primary care and to the periphery

Humanitarian Relief Sustainability: A Framework of Humanitarian Logistics Digital Business Ecosystem

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