The use of specialty training to retain doctors in Malawi

A discrete choice experiment

Datos Bibliográficos

ID4592673
AutoresKate L Mandeville (0000-0002-5525-1574, London School of Hygiene & Tropical Medicine, autor de correspondencia), Godwin Ulaya (0000-0001-7805-3928, Blantyre Institute for Community Ophthalmology), Mylene Lagarde (0000-0002-5713-2659, London School of Hygiene & Tropical Medicine), Adamson S Muula (0000-0003-4412-9773, University of Malawi), Titha Dzowela (Ministry of Health), Kara Hanson (0000-0002-9928-2823, London School of Hygiene & Tropical Medicine)
Año2016
Volumen169
Páginas109-118
Fecha de publicación2016-11-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSocial Science & Medicine (JOURNAL)
Identificadores de la revistaISSN: 0277-9536 • E-ISSN: 1873-5347
EditorialElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2016.09.034
PMID27716548
OpenAlexW2465747537
IdiomaEN
Citas recibidas6
Referencias citadas36

Emigration has contributed to a shortage of doctors in many sub-Saharan African countries. Specialty training is highly valued by doctors and a potential tool for retention. Yet not all types of training may be valued equally. In the first study to examine preferences for postgraduate training in depth, we carried out a discrete choice experiment as part of a cross-sectional survey of all Malawian doctors within seven years of graduation and not yet in specialty training. Over August 2012 to March 2013, 148 doctors took part out of 153 eligible in Malawi. Despite evidence that specialty training is highly sought after, Malawian junior doctors would not accept all types of training. Doctors preferred timely training outside of Malawi in core specialties (internal medicine, general surgery, paediatrics, obstetrics & gynaecology). Specialty preferences are particularly strong, with most junior doctors requiring nearly double their monthly salary to accept training all in Malawi and over six-fold to accept training in ophthalmology (representing a bundle of unpopular but priority specialties). In contrast, the location of work before training did not significantly influence most doctors' choices when guaranteed specialty training. Using a latent class model, we identified four subgroups of junior doctors with distinct preferences. Policy simulations showed that these preferences could be leveraged by policymakers to improve retention in exchange for guaranteed specialty training, however incentivising the uptake of training in priority specialties will only be effective in those with more flexible preferences. These results indicate that indiscriminate expansion of postgraduate training to slow emigration of doctors from sub-Saharan African countries may not be effective unless doctors' preferences are taken into account

Economic shortage · Family medicine · Graduation (instrument · Medical education · Political science · Salary · Specialty · Training (meteorology · Economic and Environmental Valuation · Global Maternal and Child Health · Healthcare Policy and Management · Medicine