Exploring Determinants for Recruitment and Retention of Family Doctors for rural Practice in Vietnam: Lessons from a Discrete Choice Experiment

In Vietnam, health professional shortage in rural and remote areas is a widely acknowledged problem. Policies promulgated up to now have had very little impact on correcting the critical geographical imbalance of health human resources. This study provides comprehensive and quantitative information to understand the determinants of recruiting and retaining family physicians for rural practice in Vietnam, to examine whether different subgroups (demographic and personal working experiences) put different values on different incentive policies, and how different the values are. To fulfill the objectives, a discrete choice experiment was designed and administered to elicit the job preferences of 315 family doctors. Data collection took place in all the regions of Vietnam (north, central, and south), which allowed the study to address characteristics of family physicians from different regions. An initial qualitative study identified three job attributes – income, career development, and government support for opening private clinic. Mixed logit regression was used for the statistical analysis of relative importance of job attributes and of individual characteristics. The findings of this study suggest that increasing current income by 50 percent has the highest impact on job location decisions for many subgroups (participants aged under 50, assistant doctors, and those with exposure to rural areas). However, the effect of income incentives decreases at a certain threshold. Non-pecuniary interventions have greater impact on some specific subgroups (those already left CHSs to higher level health facilities, individuals currently working at the national level, and individuals working in a primary health care area). It is possible that financial incentive intervention could be complemented with other types of non-financial interventions while still positively impacting family doctors’ deployment to rural areas. This research is the first attempt to provide quantitative information data regarding family physicians’ job preferences and trade-offs between different job attributes in Vietnam. This study is also the first attempt at examining how individual characteristics interact with incentive policies, then which in turn influence family doctors’ job location decisions in Vietnam setting. The findings of this study point out that it is critically important to customize incentive policies based on demographic and personal working experiences.