Address correspondence to Anthony T. Lo Sasso, Ph.D., Associate Professor and Senior Research Scientist, Division of Health Policy Administration, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor, Chicago, IL 60612, e-mail: firstname.lastname@example.org. Chiu-Fang Chou, Dr. P.H., is with the State Health Access Data Assistance Center, Division of Health Policy and Management, University of Minnesota School of Public Health, and Minnesota Population Center, Minneapolis, MN.
Practice Location Choice by New Physicians: The Importance of Malpractice Premiums, Damage Caps, and Health Professional Shortage Area Designation
Version of Record online: 7 MAY 2009
© Health Research and Educational Trust
Health Services Research
Volume 44, Issue 4, pages 1271–1289, August 2009
How to Cite
Chou, C.-F. and Lo Sasso, A. T. (2009), Practice Location Choice by New Physicians: The Importance of Malpractice Premiums, Damage Caps, and Health Professional Shortage Area Designation. Health Services Research, 44: 1271–1289. doi: 10.1111/j.1475-6773.2009.00976.x
- Issue online: 10 JUL 2009
- Version of Record online: 7 MAY 2009
- Malpractice insurance;
- health professional shortage area;
- medical residency training;
- location choice
Objective. To understand the factors affecting the choice of initial practice location by new physicians.
Data Sources/Study Setting. A unique survey of exiting medical residents in New York State from 1998 to 2003.
Study Design. We estimate conditional logit models to examine the factors affecting the choice of initial practice location by new physicians.
Data Collection/Extraction Methods. We identify all physicians completing their training in obstetrics/gynecology or surgery and primary care physicians (PCPs) (general internal medicine, pediatrics, and family medicine) who had accepted a job in patient care and who provided the location (zip code) of their job. This resulted in 3,758 physicians in our sample.
Principal Findings. Our results indicate that malpractice insurance premiums are a significant deterrent for surgeons, but they do not appear to deter OB/GYNs or PCPs from locating in particular areas. In addition, caps on malpractice damage awards attract surgeons to areas. Shortage area designations attract PCPs without education debt yet deter PCPs with debt, suggesting that subsidies do not outweigh the perceived costs of locating in underserved areas.
Conclusions. In general our results highlight that new physicians are sensitive to the characteristics of the locations in which they could potentially locate when beginning their careers in patient care.