Job preference of preventive medicine students during COVID-19 pandemic,a Discrete Choice Experiment Survey in eastern China

Background: Public health workers are a crucial part of the health workforce especially during COVID-19 pandemic and play an important role in achieving universal health coverage and sustainable development goals. In China, public health human resources are in short supply, the distribution is unequal and the turnover rate is high. DCE was applied to investigate preventive medicine students’ preferred job choice criteria and to investigate the trends in the trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of the jobs primarily selected by preventive students, and aims to estimate the monetary value of each attribute. Methods: : Based on discussions and in-depth interviews with preventive medicine students’ focus groups and a literature review, we created a discrete choice experiment (DCE) that assessed how students’ stated preference for a certain choice was influenced by various job attributes: location, salary, bianzhi , career development opportunities, working environment and workload. We applied this DCE to preventive medicine students in eastern China using a brief structured questionnaire, conditional logit models were used to estimate the utility of each job’s attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative of the cost attribute. Results: : In total, 307 respondents completed the questionnaire, and 261 respondents who passed the internal consistency test were analyzed. All attributes were statistically significant. Career development opportunities and work location were most important to respondents. There was preference heterogeneity among respondents, e.g.,3-year medical education college’s students placed higher value on jobs with bianzhi compared to 5-year medical education college’s students. Furthermore, rural students’ willingness to pay is much lower than urban students. Conclusions: : The heterogeneity of attributes showed the complexity of job preferences. Both monetary and nonmonetary job characteristics significantly influenced the job preferences of preventive students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both incentives on the job itself and the background of preventive school graduates.