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How does medical training form patient-regarding altruism of (future) doctors?

New study by Daniel Wiesen analyses patient-regarding altruism.

Doctor in green scrubs. Arms crossed. Looks friendly and approachable.

Everyone has experienced it. When one is sick, off to the doctor. Whether hospital doctors, specialists or primary care physicians, we asumme that doctors treat and advise us always in our best interests. This view somewhat neglects that a physician needs to balance his or her own interests against those of the patient. Altruism is key in the ethical behaviour of doctors. A recent study by WiSo-Professor Daniel Wiesen and colleagues analyses the formation of patient-regarding altruism among future doctors in Germany.

How altruistic are medical students? How does patient-regarding altruism develop during medical training? How does the patient-regarding  altruism of medical students depend on their individual characteristics or income expectations? To what extent is patient-regarding altruism related to intended specialty choices? These are the research questions that Professor Daniel Wiesen (Department of Business Administration and Health Care Management, WiSo Faculty of the University of Cologne) investigated with his colleagues from the University Hospital Cologne, the London School of Economics, the Erasmus University Rotterdam, and the Universities of Rennes and Bonn. Their study "The formation of physician altruism" was recently published in the Journal of Health Economics.

The study shows that freshmen exhibit the highest patient-regarding altruism, which significantly declines during the course of their medical education. In the practical year (the last year of medical school education, when students work in clinical practice), however, the altruistic motivation tends to increase again. Interestingly, it does not reach the freshmen-level again.

A total of 733 medical students of the University of Cologne took part in the study from April 2017 to December 2020, distributed across four groups: Freshmen (interviewed in the 1st week of their studies), pre-clinical studies, clinical studies and practical year. Thus, the observations of the study cover all phases of the six years of the standardised medical training in Germany. The published work is part of a longitudinal study, in which medical students are asked to participate four times in the course of their medical school education. The medical students were confronted with two treatment options in 30 scenarios, in which they had to weigh up their own financial gain against the health benefits for a patient.

The researchers also found that medical students "[...] show a high aversion to advantageous inequality". Future doctors thus seem to be more likely to reject a treatment that brings them a higher profit than the health benefit for the patient. Furthermore, altruism is correlated with students’ personal characteristics. For example, general social preferences were consistent with patient-related altruism. Interestingly, female medical students show a higher altruistic concern for patients in that they weighted the health benefits for patients significantly higher than their own gain. Moreover, less profit-oriented medical students also expect a lower income when they practise medicine in the future.

Specialisation choices are correlated with the patient-regarding altruism of the medical students. Students who weighted the patient's health benefit comparatively higher than their own profit were significantly more likely to opt for the specialties of paediatrics and surgery.

In sum, the study results provide very interesting insights for health policy addressing the growing shortage of doctors and healthcare workers. The researchers around Daniel Wiesen believe that their results can inform the ongoing political debate. For instance, when policy makers aim to change the selection criteria in the admission and training of future doctors to cope with the ongoing healthcare worker shortage, the importance of future doctors’ altruistic preferences need to be taken into account.