Characteristic profiles among students and junior doctors with specific career preferences

Abstract

Background: Factors influencing specialty choice have been studied in an attempt to find incentives to enhance the workforce in certain specialties. The notion of "controllable lifestyle (CL) specialties," defined by work hours and income, is gaining in popularity. As a result, many reports advocate providing a 'lifestyle-friendly' work environment to attract medical graduates. However, little has been documented about the priority in choosing specialties across the diverse career opportunities.This nationwide study was conducted in Japan with the aim of identifying factors that influence specialty choice. It looked for characteristic profiles among senior students and junior doctors who were choosing between different specialties.

Methods: We conducted a survey of 4th and 6th (final)-year medical students and foundation year doctors, using a questionnaire enquiring about their specialty preference and to what extent their decision was influenced by a set of given criteria. The results were subjected to a factor analysis. After identifying factors, we analysed a subset of responses from 6th year students and junior doctors who identified a single specialty as their future career, to calculate a z-score (standard score) of each factor and then we plotted the scores on a cobweb chart to visualise characteristic profiles.

Results: Factor analysis yielded 5 factors that influence career preference. Fifteen specialties were sorted into 4 groups based on the factor with the highest z-score: "fulfilling life with job security" (radiology, ophthalmology, anaesthesiology, dermatology and psychiatry), "bioscientific orientation" (internal medicine subspecialties, surgery, obstetrics and gynaecology, emergency medicine, urology, and neurosurgery), and "personal reasons" (paediatrics and orthopaedics). Two other factors were "advice from others" and "educational experience". General medicine / family medicine and otolaryngology were categorized as "intermediate" group because of similar degree of influence from 5 factors.

Conclusion: What is valued in deciding a career varies between specialties. Emphasis on lifestyle issues, albeit important, might dissuade students and junior doctors who are more interested in bioscientific aspects of the specialty or have strong personal reasons to pursue the career choice. In order to secure balanced workforce across the specialties, enrolling students with varied background and beliefs should be considered in the student selection process.

Figure 1

Fulfilling-life oriented group. The 6th year medical students and residents who chose one of the specialties in this group as the single most probable specialty or only specialty under consideration showed the highest z-score in the factor of “fulfilling life with job security” compared to other 4 factors, and there was more than 5 (=1 SD) difference between the highest and the lowest scores. The z-score was calculated from the mean of each factor in the specialty, and mean and SD of all valid responses in this survey. The z-score of 50 indicates that the mean of the factor is average of the whole group. The higher the z-score, the more the influence of the factor in choosing the specialty compared to other factors within the specialty or in other specialties.

Figure 2

Bioscientific-orientation group. Respondents who chose one of these specialties as the most probable career showed higher z-score in factor of bioscientific-orientation compared to other 4 factors. The “fulfilling life” factor ranked second lowest in internal medicine subspecialty and the lowest in other specialties in this group. At the same time, z-score of “educational experience” was ranked second highest among specialties in this group.

Figure 3

Personal-reasons group. Respondents who chose paediatrics or orthopaedics as the most probable career showed the highest z-score in factor of “personal reasons” and the lowest score in “fulfilling life” factor with more than 1SD difference between the two.

Figure 4

Intermediate group. The difference of the highest and lowest z-scores among 5 factors was less than 5 (=1SD) in the respondents choosing general medicine/family medicine or otolaryngology as the most probable career. Because of the similar weight of the 5 factors, General/family medicine and otolaryngology were both categorized as an “intermediate group”. In respondents who considered general medicine/family medicine as their future specialty, the z-scores of all 5 factors were less than 50, which implies external variables relevant to primary care preference were missing in the questionnaire.