Why do specialists choose to work in the public sector? It’s not money


By Megan Howe

25 Aug 2020

Specialists prefer to work in the public sector over the private sector, with factors such as the chance to take clinical risks more likely to influence their choice of workplace than income, an Australian study suggests.

Researchers surveyed 3422 non-GP specialists from the Medicine in Australia: Balancing Employment and Life (MABEL) survey, using a discrete choice experiment to assess their preferences for job characteristics and public or private sector work.

A previous study using the same MABEL dataset showed that 48% of medical specialists combined public and private sector work, 19% worked the private sector only and 33% worked in the public sector only

In this study, respondents were given scenarios of jobs with differences in earnings, hours worked, on-call arrangements, percentage of time in private practice, teaching and research opportunities, time spent in administration and location. They were asked which they would prefer, including the option of staying in their current job.

While specialists chose the status quo of their current job 81% of the time, the authors said the overall findings were as expected:

“Specialists prefer higher earnings, fewer hours, less on-call, more teaching and research opportunities, less administration and working in metropolitan areas,” they wrote in Human Resources for Health.

However, on average, specialists preferred working in the public sector, with preferences for time spent in the public outweighing the private sector.

That was despite the factor that financial value of the public sector work  was “very small” – at 0.14% of their annual earnings to work an additional hour per week.

Lower wage earners were found to prefer the public sector while those with higher wages preferred the private sector, although the associations were small, according to findings

The respondents were also asked about their attitudes to financial risk, career and professional risk (e.g. publicly challenging your professional colleagues), and clinical risk (e.g recommending a new or controversial treatment).

Doctors averse to clinical and career risk were found to have a strong preference for the private sector, which the author suggested was likely due to the job characteristics.

“Although career trajectories are more well-defined in the public sector, there is more tournament-type competition between specialists to work in trajectory teaching hospitals to undertake high quality research and teaching,” they wrote.

They suggested that doctors who preferred taking clinical risks may choose the public sector because it involved more complex and challenging cases.

Private sector work was preferred by men aged 65-70 years – perhaps to boost retirement income or because they preferred less challenging work in the lead up to retirement.

Female specialists with dependent children also had a stronger preference for working more hours in the private sector, which the authors said was likely because they sought more autonomy and flexibility over working hours.

“The results suggest that non-wage factors play a stronger role in sector choice compared to wages and the sector itself,” the authors wrote.

Dermatologist Associate Professor Stephen Shumack, a senior staff specialist at Royal North Shore Hospital in Sydney who also works in private practice, said there were factors other than money for doctors to consider when choosing between the public and private sectors.

“People aren’t in [public] hospitals for the money, whether they are a VMO or a staff specialist, they can get more money outside,” he said.

He suggested the opportunity to “give back” by teaching was a significant attraction of public sector jobs.

“Doctors do see it from the point of view of giving back, by teaching registrars and medical students,” he said.

Associate Professor Shumack, also a clinical professor at the University of Sydney, said there were also greater clinical challenges in the public hospital sector where the sickest patients were treated, along with opportunities to discuss cases with colleagues and an expectation for doctors to be able to defend their clinical decisions.

“Even in dermatology, we occasionally have some life and death situations which are seen in tertiary referral hospitals,” he said.

But rather than doctors seeking out risk by working in the public sector, he suggested it may be the reverse – that doctors who did not want to be exposed to clinical risk were more likely to choose private practice.

In terms of career trajectories, he said it may vary by specialty (which wasn’t explored it the study), but some specialists saw employment in a teaching hospital as a pathway towards a university professorship.

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