Doctors' career choices in health systems constrained by national medical exams: A discrete choice experiment

Previous studies that addressed factors influencing junior doctors' career decisions have failed to consider that the market for medical specialty is regulated and doctors are not always able to pursue their career of choice. There is the concern that the National Medical Exam that doctors have to take in many countries conditions their career choices and is behind the low efficacy of policies for retaining doctors in rural areas. In this paper, we use data from a Discrete Choice Experiment applied to a large sample of Portuguese junior doctors (N = 503) who had already taken their Medical Exam but had not chosen their medical specialty yet. We show that the exam score is de facto a strong predictor for (different) job preferences, but only for doctors who are amongst the highest and the lowest exam scores. For all others—almost half of our sample—geographical attachment (having lived or studied in rural areas or in metropolis) is more relevant in determining specialization decisions. Having a good work‐life balance, specially amongst female physicians, is also an important determinant of specialty choice. Using latent‐class analysis may help policymakers profiling different groups of doctors and tailoring incentive packages according to their characteristics.