The role of direct single monetary grants in residents' choice of field of residency

Unpopular medical specialties: exploring the concept that "the customer knows best"

BACKGROUND

Healthcare systems often face shortages of certain medical specialists due to lack of interest among medical students. We questioned a common "one solution fits all" approach to this problem which involves monetary incentives to lure students to these specialties. Instead, we used the marketing principle the "consumer knows best" to explore ways of elucidating the reasons and proposing solutions for such shortages.

METHODS

A convenience sample of Israeli 6th-year medical students and interns completed questionnaires to determine why they thought three specialties (geriatrics, anesthesiology, emergency medicine) were unpopular and their ideas on increasing their appeal.

RESULTS

119 6th-year students and 84 interns completed questionnaires. Geriatrics was reported having a problematic patient population; not being interesting and challenging; and not considered prestigious by colleagues and the populace. This contrasts with emergency medicine which, although considered prestigious, has difficult working conditions both during and after residency accompanied by much pressure at work. Although, improvements in lifestyle and remuneration were thought by students and interns as possibly making these specialties more attractive, reducing the pressure at work and decreasing on-call obligations were designated by the students/interns as ways to increase emergency medicine's and anesthesiology's appeal. Half the students replied that anesthesiology would be more appealing if work was in shifts (< 16 h), while 60% replied so for emergency medicine and only 18% for geriatrics. 90% of students reported that control over lifestyle would make emergency medicine more attractive while 55% and 48% replied positively for anesthesiology and geriatrics, respectively.

CONCLUSIONS

Using the concept "consumer knows best" provided additional insight into the specialty selection process. Students/interns have specialty-specific opinions as to why some specialties are unpopular. Their ideas about attracting more students to these specialties were also specialty-dependent, i.e. "one solution does not fit all". These observations render problematic a single solution aimed at ameliorating the workforce shortages of multiple specialties. Instead, these results advocate a differential approach wherein the lack of appeal of each unpopular specialty is analyzed individually and the students'/interns' (the "consumers") ideas sought resulting in solutions tailored to address each specialty's lack of attractiveness.

TRIAL REGISTRATION

None.

Using financial incentives to attract medical residents to the periphery: The Israeli experience

BACKGROUND

In 2011, Israel instituted financial incentives as part of a larger program to attract doctors to residency programs in peripheral hospitals.

OBJECTIVE

To explore the impact of these incentives and related changes on the choices of locations for residency training in Israel.

METHODS

We performed (A) an analysis of administrative data on the location of all new medical residencies in 2005-2014 (B) an internet/phone survey of residents who began specialty training in 2013-2014, with a response rate of 71%.

RESULTS

(A) Of all entrants to residency training programs in Israel, those in peripheral hospitals constituted 16-20% in 2005-2010, 19% in 2011, 23% in 2012, and 23% in 2013; the increase consisted predominantly of physicians who were graduates of non-Israeli medical schools (B) About half of all residents in the periphery reported that the incentives contributed to their choice of residency location. About 40% of that group also reported that they had planned already in medical school to practice in the periphery, while 60% of that group (30% of all residents in the periphery) did not have such plans prior to medical school. About 70% of the residents in peripheral hospitals grew up in the periphery; for the southern periphery this was 40% and for the northern periphery this was 80%.

CONCLUSIONS

The changes instituted in 2011 apparently affected residency location preferences for a non-negligible proportion of young physicians, particularly among those who grew up in the periphery. Policymakers should consider combining targeted incentives with measures to increase the supply of physicians who grew up in the periphery.

Personality traits and career choices among physicians in Finland: employment sector, clinical patient contact, specialty and change of specialty

BACKGROUND

Personality influences an individual's adaptation to a specific job or organization. Little is known about personality trait differences between medical career and specialty choices after graduating from medical school when actually practicing different medical specialties. Moreover, whether personality traits contribute to important career choices such as choosing to work in the private or public sector or with clinical patient contact, as well as change of specialty, have remained largely unexplored. In a nationally representative sample of Finnish physicians (N = 2837) we examined how personality traits are associated with medical career choices after graduating from medical school, in terms of employment sector, patient contact, medical specialty and change of specialty.

METHODS

Personality was assessed using the shortened version of the Big Five Inventory (S-BFI). An analysis of covariance with posthoc tests for pairwise comparisons was conducted, adjusted for gender and age with confounders (employment sector, clinical patient contact and medical specialty).

RESULTS

Higher openness was associated with working in the private sector, specializing in psychiatry, changing specialty and not practicing with patients. Lower openness was associated with a high amount of patient contact and specializing in general practice as well as ophthalmology and otorhinolaryngology. Higher conscientiousness was associated with a high amount of patient contact and specializing in surgery and other internal medicine specialties. Lower conscientiousness was associated with specializing in psychiatry and hospital service specialties. Higher agreeableness was associated with working in the private sector and specializing in general practice and occupational health. Lower agreeableness and neuroticism were associated with specializing in surgery. Higher extraversion was associated with specializing in pediatrics and change of specialty. Lower extraversion was associated with not practicing with patients.

CONCLUSIONS

The results showed distinctive personality traits to be associated with physicians' career and specialty choices after medical school independent of known confounding factors. Openness was the most consistent personality trait associated with physicians' career choices in terms of employment sector, amount of clinical patient contact, specialty choice and change of specialty. Personality-conscious medical career counseling and career guidance during and after medical education might enhance the person-job fit among physicians.