Specialty choice in times of economic crisis: a cross-sectional survey of Spanish medical students

Abstract

Objective: To investigate the determinants of specialty choice among graduating medical students in Spain, a country that entered into a severe, ongoing economic crisis in 2008.

Setting: Since 2008, the percentage of Spanish medical school graduates electing Family and Community Medicine (FCM) has experienced a reversal after more than a decade of decline.

Design: A nationwide cross-sectional survey conducted online in April 2011.

Participants: We invited all students in their final year before graduation from each of Spain's 27 public and private medical schools to participate.

Main outcome measures: Respondents' preferred specialty in relation to their perceptions of: (1) the probability of obtaining employment; (2) lifestyle and work hours; (3) recognition by patients; (4) prestige among colleagues; (5) opportunity for professional development; (6) annual remuneration and (7) the proportion of the physician's compensation from private practice.

Results: 978 medical students (25% of the nationwide population of students in their final year) participated. Perceived job availability had the largest impact on specialty preference. Each 10% increment in the probability of obtaining employment increased the odds of preferring a specialty by 33.7% (95% CI 27.2% to 40.5%). Job availability was four times as important as compensation from private practice in determining specialty choice (95% CI 1.7 to 6.8). We observed considerable heterogeneity in the influence of lifestyle and work hours, with students who preferred such specialties as Cardiovascular Surgery and Obstetrics and Gynaecology valuing longer rather than shorter workdays.

Conclusions: In the midst of an ongoing economic crisis, job availability has assumed critical importance as a determinant of specialty preference among Spanish medical students. In view of the shortage of practitioners of FCM, public policies that take advantage of the enhanced perceived job availability of FCM may help steer medical school graduates into this specialty.

Figure 1

Percentage of candidates participating in the Annual Internship-Residency (MIR) Selection Process who elected training position in Family and Community Medicine, 1996–2012. Adjacent to each point is the total number of candidates participating in the MIR selection process in the corresponding year. Source: Compiled from annual data provided by the Ministerio de Sanidad y Política Social, Subdirección General de Ordenación Profesional, Spain. MIR, Médico Interno Residente.

Figure 2

Effect of a 1-point increment in Lifestyle and Work Hours rating on OR of preferring a specialty. We used the results of model 4 to compute the predicted effect for each individual student of a 1-point increment in attribute 2 (Lifestyle and Work Hours). Each open point in the figure represents one student. The points are arranged in rows corresponding to the student's preferred specialty. The horizontal axis gauges the predicted effect of a 1-point increment on a 10-point scale of favourable lifestyle and work hours. The solid blue squares represent the population mean effect for students in each preferred specialty. Not shown are preferred specialties with fewer than 10 respondents.

Figure 3

Concordance of preference with favourite specialty. For each preferred specialty, the black points show the proportion of students who also designated that specialty as their favourite.

Figure 4

Median predicted probability of specialty preference in relation to the median specialty ranking in the 2012 MIR selection process. CALM, Clinical Analysis & Laboratory Medicine; CN, Clinical Neurophysiology; ENT, Otorhinolaryngology; FCM, Family and Community Medicine. Ob-Gyn, Obstetrics and Gynaecology; PMPH, Preventive Medicine and Public Health; RM, Rehabilitation Medicine.