What drives family physicians to rural practice? A discrete choice experiment in Vietnam

Despite commune health stations serving as the backbone of Vietnam's primary healthcare, severe physician maldistribution persists. To explore factors influencing the recruitment and retention of family physicians in rural areas, we conducted a discrete choice experiment among 315 family physicians in Vietnam. Mixed logit regression was used to estimate the relative importance of individual characteristics and key job attributes, which included income change, career promotion, living condition, and government support for private clinics. Our findings indicate that a 50% increase in salary has the most significant influence on rural job uptake for key subgroups, including those under 50, assistant doctors, and those with prior rural exposure. However, the marginal utility of financial incentives diminishes rapidly beyond a specific threshold. Subgroup analysis further reveals heterogeneous preferences: physicians who transitioned from commune health stations to higher-level facilities, and those working in primary health care areas, respond more strongly to non-financial incentives such as career promotion and private practice support than to additional income increases. Physicians would forgo 48.36% of their salary to secure an urban posting, yet would accept a rural position if offered expedited promotion or private practice support, each valued at approximately 38% of monthly income. Achieving sustainable rural deployment therefore requires differentiated rather than uniform intervention: moderate salary increases for younger and rural-exposed physicians, combined with accelerated promotion pathways and private practice facilitation for those in primary health care and higher-level facilities. Translating stated preferences into actual rural uptake ultimately hinges on government credibility in delivering promised benefits.