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Open Access Publications from the University of California

Altruism and Efficiency Preferences of U.S Medical Students and Their Expected Specialty Choice

  • Author(s): Li, Jing
  • Advisor(s): Dow, William H
  • et al.

The quality of a nation's healthcare system depends heavily on physicians. Particularly in the U.S., a significant portion of a physician's job involves balancing among three often competing interests: their own financial self-interest, patients' economic or health interests, and the interests of the payers representing the larger healthcare system. Physician choices in the face of these tradeoffs depend on physicians’ underlying social preferences regarding factors including altruism and efficiency, on which previous literature has provided little direct insight.

We measure the social preferences of a sample of 503 medical students from schools around the U.S. using an experimental approach. The approach allows us to decompose social preferences into two qualitatively different tradeoffs: the tradeoff between self-interest and other’s benefit (altruism), and the tradeoff between equality and efficiency. 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. We also collect rich individual-level information for the same sample from a survey we fielded. We examine heterogeneity in social preferences of medical students by expected specialty choice, with particular emphasis on specialty choice. Large variation in income and practice patterns across specialties in the U.S. means that in certain specialties, less altruistic behavior of physicians can yield significant financial gains, and less regard for efficiency can potentially lead to excessive waste.

We find substantial heterogeneity in altruistic preferences among experimental subjects. Medical students with a lower degree of altruism are significantly more likely to choose high-income specialties: the half of the sample who are less altruistic in the experiment chooses specialties that earn on average around $40,000 more annually than their more altruistic peers. This altruism measure is more predictive of specialty than a wide range of other characteristics, including parental income, student loan amount and Medical College Admission Test (MCAT) score. We also find that this altruism measure predicts students' self-reported likelihood of practicing medicine in an underserved area.

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