General vs subspecialty pediatrics: factors leading to residents' career decisions over a 12-year period

Abstract

Objectives: To determine factors motivating residents' career choices and to examine changes in these priorities over the last 12 years. During the last decade, surveys of pediatric training programs have shown trends toward residents choosing careers in general pediatrics rather than in subspecialties. Most recently, there is evidence of a shift back toward subspecialty careers.

Design: We surveyed past and present residents at The Children's Hospital of Philadelphia, Philadelphia, Pa, (training completion dates, 1991-2002) via an anonymous written questionnaire.

Results: The sample comprised 238 residents (mean +/- SD age, 30 +/- 3 years; 59% female, 41% male; 47% subspecialists, 53% generalists). Among the group as a whole, subject matter, role models, lifestyle issues, and teaching were the most important determinants for career choices. Less important were national trends, job openings, and research. When subspecialists and generalists were compared, both groups found subject matter to be their highest priority. Among residents interested in subspecialties, teaching, research, and technical skills were significant (P<.001), compared with generalists, who considered lifestyle and personal/financial issues more important (P<.001). Lifestyle issues were also more important to female residents, those 30 years of age or younger, and those completing training recently (P<.05).

Conclusions: Career decisions for pediatric residents today are motivated by complex factors. For those choosing generalist careers, lifestyle and personal/financial considerations predominate, while teaching, research, and technical skills are key factors for subspecialists. Over the last decade, lifestyle issues have become a more dominant factor, particularly for women entering the pediatric workforce.