Location strategies of French general practitioners: economic or hedonistic mechanisms?

Summary In France, medical density is high but general practitioners are very unevenly distributed throughout the country. Because it raises questions of equity and efficiency, this uneven distribution is now a major issue in the regulation of medical demography. An exhaustive sample of 9,000 general practitioners who began their careers in private practice between 1997 and 2002 is mobilized in order to analyze the determinants of individual location choices of general practitioners and, thus, to report on the tools that could be used specifically at the regional level to modify their location behaviors. We model two decisions: the choice to change region between the date of the thesis defense and the installation and the choice of the region of practice for doctors who leave the region where they have defended their thesis. Through these individual choices, we study in particular the monetary attractiveness of the regions in order to determine to what extent the behaviour of doctors could be influenced by the introduction of installation bonuses in areas with a low number of doctors. We observe a marked sedentary behaviour among physicians, the vast majority of whom settle in the region of their thesis. Policies must therefore be directed, as a priority, towards medical students. We also show that financial incentives to settle in areas with a low supply of doctors could influence the location of doctors, even if the resulting change in distribution would be quantitatively small. Indeed, the premiums would have to be very high to compensate for the loss of quality of life agreed to by the doctors. Financial incentives cannot therefore be the only means of correcting inequalities in the distribution of physicians.