It's not all about money: Exploring health workers' motivation when choosing a workplace

Healthcare systems across the world, be they in developed or developing countries, are facing serious challenges in managing their workforce. For some of them, the challenges are related to an increasingly mobile workforce, which leaves positions unoccupied, risking the health of communities, while for others they are related to skill mix, planning or forecasting the needed number of health professionals. However, despite these specific challenges, it has been widely recognized that innovative strategies should be pursued in order to address all these challenges. Romania, an upper-middle income country, member of the European Union since 2007, is currently experiencing difficulties in retaining and motivating its health professionals. Especially since Romanian joined the European Union, which allowed for increased mobility, health professionals are leaving the country, while no mechanisms are in place to manage this phenomenon. In this paper, we explore physicians' and nurses' perspectives on the factors that motivate them to choose a specific workplace. We surveyed 234 physcians and nurses working in two hospitals in Cluj County, Romania. We employed Discrete Choice Experiments to elicite their preferences for specific attributes and attribute levels related to a workplace. Our data showed that, apart from monthly wages, other equally important factors are the work environment, the opportunities for career advancement and hospital location. This data is highly relevant in a country where no databases are hold with health professional mobility information, to inform policies aimed at increasing workforce retention and motivation. We show here that increasing salaries only is not a solution, and efforts should be directed towards providing up-to-date equipment and technology, as well as creating healthy organizational cultures and ensuring fair professional development opportunities.