Medical students' perspectives on earning opportunities of self-employed physicians - realistic and relevant for the process of career choice?

Influence of Selected Environmental Factors on the Business Type of Dentist's Practice in Germany: A Multi-Criteria Decision-Making Process With an Analytical Hierarchy Process

In the interests of satisfying the dental services demands of German citizens area-wide, constant, and thoughtful planning of supply and demand is essential. With an anonymous online survey of 375 dentists a pairwise comparison of 9 factors extracted as relevant from the existing scientific literature were analyzed with an analytic hierarchy process (AHP) and ranked considering the various business types. In general, 5 local environmental factors have a dominant impact on founders' decision in German dentistry. In order: environment for the family, quality of life in private environment, real income, location of the practice, infrastructure. Real income is in first place (p = 0.287) for dentists who want to start a new single practice. For preferring a new community practice, it is on third place (p = 0.177) and for dentists who favor a takeover a single practice (p = 0.130) or joining a community practice (p = 0.096) or employment (p = 0.111) it is fourth place. For this purpose, the location of the practice is of greater priority than the real income for dentists who prefer not to start a new practice. The AHP method is a way to picture a priority list out of all relevant factors for setting up of a dental practice.

Location Factors Impact the Career Choice of German Dental Practitioners - An Empirical Analytical Approach to Multi-Criteria Decision-Making

Objectives

In light of the increasing number of employed dentists and the decreasing rate of self-employed dentists, the factors that impact the decision to set up a dental office in Germany were investigated. Central to this approach is the provision of comprehensive dental care.

Methods

Using a pairwise comparison technique, the analytic hierarchy process (AHP), location factors identified as relevant in a systematic literature review and then prioritized by the professionals were weighted and ranked.

Results

According to this, five factors generally dominate the decision to open a dental office. These are, in descending order: environment for the family, quality of life in the private environment, real income, perception of location, and good infrastructure. The strongest impact on the rank order of the influencing factors is the socio-demographic characteristic of gender. For female dentists, the family environment is in the first place (p  =  .3196/C.R.  =  0.1502). For male colleagues, this influence ranks third (p  =  .1550/C.R.  =  0.1468) and real income receives the first place (p  =  .244/C.R.  =  0.1468). For female dentists, the influence of income ranks fifth (p  =  .076/C.R.  =  0.1502). Female and male dentists who grew up in rural areas were less likely to prefer employment (13.6%) than subjects of urban origin (40.2%).

Conclusion

The method of AHP is a way to map a priority list of all relevant factors. It can successfully show variations related to specific personal attributes. Obviously, there are factors that are of greater importance for the decision-making process to set up a dental office.

Attitudes of medical students and junior physicians towards working self-employed in private practice in Northern and Western Europe: a systematic review

Aim

A shortage in primary care physicians has been a well-known challenge in many Western countries for several years. In addition, we currently see a trend in primary care, where an increasing number of physicians work as employees instead of being self-employed, even among general practitioners. To address this shortage, knowledge of the future specialists’ attitudes toward working self-employed is needed. This qualitative systematic review aims to explore the attitudes of future specialists towards self-employment in private practice, and what factors influence these attitudes.

Subject and methods

We conducted a systematic search using PubMed, Embase, and Web of Science. We developed a search strategy that collected terms for future specialists, career choices, and self-employment and linked these with the Boolean operator “AND”. We analysed the results using a qualitative content analysis, as both qualitative and quantitative studies were included in the research.

Results

Self-employment is less attractive to future specialists. In particular, women prefer to be employed and receive a fixed salary. The main factors that influence the decision as to whether to become self-employed or not are financial conditions, bureaucracy and non-medical tasks, organisation, job satisfaction during residency, personal responsibility, career opportunities, specialty-dependent factors, personal environment, and education.

Conclusion

Among future specialists, being self-employed is less attractive than being an employee. Students should be better informed about future career opportunities to make an informed decision. However, it should be examined whether other forms of organisation are more in line with the wishes of future specialists.

Workshop with medical students on physicians' earning opportunities, workload and job satisfaction increases the attractiveness of working self-employed and working in general practice

BACKGROUND

Among the various factors identified as relevant for primary care career choice, financial considerations have been consistently shown to have an impact. In Germany, reliable and easily understandable information on physicians' earning opportunities in self-employed settings is difficult to obtain for medical students, leading to substantial misperceptions that may negatively affect respective career considerations. This study investigated medical students' evaluation of a 45-min evidence-based workshop on earning opportunities, workload and job satisfaction in different specialties and settings to examine its effect on the perceived attractiveness of working self-employed and working in general practice.

METHODS

The workshop was implemented as part of a mandatory general practice clerkship in the fourth study year (of six). Post-hoc evaluations of all participants between October 2017 and September 2018 (one cohort) were analysed cross-sectionally including descriptive statistics, subgroup comparisons and qualitative analysis of free-text answers regarding students' main insights.

RESULTS

Response rate was 98.1% (307/313). Participants were on average 25.0 years old, and 68.3% were women. Based on a ten-point scale ranging from 1 = 'no influence' to 10 = 'very big influence', 91.9% confirmed at least some (> = 2) and 57.3% a rather high (> = 5) influence of earning expectations on their career choice process. Regarding the workshop, 86.1% were overall satisfied, and 89.5% indicated they had gained new insights, primarily regarding earning opportunities in different specialties and work settings, and frequently regarding job satisfaction, workload and the structure of revenues and expenditures in a doctor's office (according to qualitative analysis). In the opinion of 89.8% of students, the provided learning content should be part of the undergraduate curriculum. More than half of participants reported an increase regarding the attractiveness of working self-employed and working as a general practitioner, most frequently regarding earning opportunities, but also in general and in respect to job satisfaction, cost-benefit ratio and workload. This increase was significantly higher among students favouring or at least considering a general practice career.

CONCLUSIONS

The workshop and its content were appreciated by the students and showed clear potential to usefully complement undergraduate curricula aiming at increasing or reinforcing students' interest in working self-employed and working in general practice.

Earning opportunities and informal payment as influencing factors in medical students' speciality choice

Background

The Hungarian primary care system faces a severe shortage of family physicians. Medical students’ perceptions of family medicine need to be known and medical students need to be given appropriate and comprehensible information about this speciality. The expected future salary is an important factor in career choice. Most of the family doctors are self-employed and the practices have a corrected capitation-type financing. Although the majority of health care services are covered by social health insurance and are provided for the insured patients free of charge, informal payment is an existing phenomenon with different motivations and consequences. This study aimed to investigate medical students’ knowledge about their future earning opportunities and their attitudes towards informal payment.

Methods

A cross sectional survey with a self-administered questionnaire was conducted. Each of the four Hungarian medical universities were represented by their medical students who attended family medicine lectures in person from December 2019 to April 2020. The students were asked about their career plans, about their estimations of current and ideal expected salaries and about the effect of expected income for the choice of specialisation. Their attitudes towards informal payment were assessed.

Results

Response rate was 67.3% (N = 465/691). Almost two-thirds of the participants were women. Only 5% of the respondents (N = 23/462) plan to work as a family doctor in the future. The vast majority (91.9%) of the students had already thought about their future income. On a 10-point Likert scale (1 = ‘no influence’, 10 = ‘very big influence’) 76% answered that the expected future income exerts a considerable (≥5 Likert points) influence on their career choice in general. The mean of the ideal expected monthly income of the residents, GPs and other specialists was €1154 ± 648, €1696 ± 904 and €2174 ± 1594, respectively. The mean of the monthly income for a GP, as estimated by the studenst, was €1140 in rural and €1122 in urban settings. More than four-fifths of the students (N = 375/453) rejected the practice of informal payment.

Conclusions

Expected salaray is one important aspect in the career choice of medical students, students wish to have more information on this topic. The reported ideal incomes are higher than those expected. This points to a relevant gap. However, most of the students do not accept informal payment as a possibility to close this gap. The expected and the ideal income differ from the real incomes of Hungarian GPs – this indicates the need of bringing objectoive information to the students to enhance attractivity of GP as a carer choice.