Plastic surgery or primary care? Altruistic preferences and expected specialty choice of U.S. medical students

Understanding physicians’ decisions when faced with conflicts between their own financial self-interest and patients’ economic or health interests is of key importance in health economics and policy. This issue is especially salient in certain medical specialties where less altruistic behavior of physicians can yield significant financial gains. This study examines experimentally measured altruistic preferences of medical students from schools around the U.S., and whether these preferences predict those students’ expected medical specialty choice. The experimental design consists of a set of computer-based revealed preference decision problems, which ask the experimental subjects to allocate real money between themselves and an anonymous person. These data are used to derive an innovative measure of altruism for each participant. I then examine the association between altruism and expected specialty choice, after controlling for an extensive set of covariates collected from an accompanying survey questionnaire. Medical students with a lower degree of altruism are significantly more likely to choose high-income specialties, conditioning on an extensive set of covariates. This altruism measure is more predictive of income of specialty choice than a wide range of other characteristics, including parental income, student loan amount and Medical College Admission Test (MCAT) score. On the other hand, the altruism measure does not predict choosing primary care specialties. I also find that altruism predicts students’ self-reported likelihood of practicing medicine in an underserved area.