Can We Trust the Doctors? Physician Altruism, Specialty Choice and Selection into the Medical Profession

Physician behavior is the central issue in health economics and health policy in general. At the core of physician behavior is physicians’ choice under conflict between self-interest and patient benefit. In this study, we employ an experimental approach to examine physician altruism when faced with a tradeoff between self profit and patient benefit. We recruit subjects of both medical students and non-medical graduate students in the US to allow assessment of selection into the medical profession based on distributional preferences. Further, we use information on choice of specialty among medical students to measure the association between altruism and specialty choice. The experimental design, derived from standard Microeconomic theory of utility maximization, consists of a set of computer-based decision problems involving tradeoff between benefit to self and to hypothetical patients. We mimic variation in provider payment in reality by varying the relative price of trading off patient benefit for self profit in the course of the experiment. We model utility function as a constant elasticity of substitution (CES) function, which yields estimation of parameters on both indexical selfishness and equality-efficiency tradeoff for each individual. We then use a discrete choice model to estimate the impact of altruism on decision of entering the medical profession and choice of specialty. We hypothesize that there will be substantial heterogeneity in distributional preferences among experimental subjects. In addition, the association between degree of altruism and specialty choice will be consistent with findings in previous literature in the field of psychology and career assessment. This study contributes to both the theoretical and empirical understanding of physician behavior and introduces the prominant methods from experimental economics to the field of health economics and health policy.