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González López-Valcárcel B, Barber Pérez P. [What do we know and what should we know about the imbalances of doctors in Spain? Diagnosis and proposals. SESPAS Report 2024]. GACETA SANITARIA 2024; 38 Suppl 1:102366. [PMID: 38373866 DOI: 10.1016/j.gaceta.2024.102366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024]
Abstract
This article characterizes the main features of the supply, demand, and labor markets for physicians in Spain, with an international and territorial perspective. It also presents some of the results of the simulation model for specialist physicians with a 2035 horizon and proposes strategic and short-term lines of action in the planning, regulation, and management of health professionals in Spain, with a focus on specialist physicians. In Spain there are high rates of physicians and medical graduates, but low rates of nurses, compared to other developed countries. Approximately 30% of practicing physicians (not considering residents) practice only in the private network. In the last two decades, competition from the private sector for health professionals has intensified, competing with the public network, which is subject to an excessively rigid regulatory framework. There is currently a shortage of physicians in some specialties, particularly in family medicine, which urgently needs specific incentives to stimulate vocations. Numbers consider only part of the story. The imbalances in the educational and labor markets are not resolved by creating vacancies, but by reforming the regulatory framework, the incentive systems, and the slack in public management to compete with the private sector in attracting and retaining talent.
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Affiliation(s)
| | - Patricia Barber Pérez
- Universidad de Las Palmas de Gran Canaria, Campus de Tafira, Las Palmas de Gran Canaria, España
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Soqia J, Yakoub-Agha L, Mohamad L, Alhomsi R, Shamaa MA, Yazbek A, Alsaid B. Syrian crises effect on specialty choice and the decision to work in the country among residents of six major hospitals in Syria, Damascus. PLoS One 2024; 19:e0295310. [PMID: 38329984 PMCID: PMC10852239 DOI: 10.1371/journal.pone.0295310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/20/2023] [Indexed: 02/10/2024] Open
Abstract
Assessing the impact of war on medical residents' specialty choices and migration decisions is critical to ensure the sustainability of healthcare systems worldwide. This study aimed to evaluate the effect of the Syrian crisis on specialty choices, related factors, and decisions to work in Syria among residents of six major university hospitals in Damascus. A cross-sectional study was conducted using a validated questionnaire from 20/4/2022 to 20/5/2022, including all eligible residents with no missing data. The questionnaire was comprised of 68 items, and residents were divided into two groups: group 1 included residents who made their specialty choice after the end of the military war in Damascus 2018, while group 2 included residents who made their specialty choice (the point of submitting their lists and applying for residency) during the war. A total of 370 residents were included, with 38.4% females and 61.6% males. Our findings revealed that 30% of residents preferred working in Syria, while 43.5% preferred working abroad. The factor of a "safer and more stable life" was significantly higher in Group 1 than in Group 2 (3.86>3.5, p-value = 0.026). Additionally, Group 1 residents were more likely to choose radiology, pathology, laboratory, and psychiatry specialization as their specialties, while choosing surgical specializations and hematology decreased compared to Group 2 (p-value<0.05). Factors related to social life were rated higher by group 1 (mean = 3.31) than by group 2 (mean = 2.27, Standard deviation = 0.19, p-value = 0.002). Moreover, the factor of "a specialization to facilitate traveling abroad" was significantly higher in Group 1 (2.69>2.21, Standard deviation = 0.22, p-value = 0.033). The Syrian crisis and its economic aftermath have influenced residents' specialty choices and practice locations. Even after the war's end, the high level of migration intentions could negatively affect the quality of provided healthcare services.
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Affiliation(s)
- Jameel Soqia
- Laboratory of Anatomy, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Laila Yakoub-Agha
- Laboratory of Anatomy, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Lama Mohamad
- Laboratory of Anatomy, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rawan Alhomsi
- Laboratory of Anatomy, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Albaraa Yazbek
- Laboratory of Anatomy, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Bayan Alsaid
- Laboratory of Anatomy, Faculty of Medicine, Damascus University, Damascus, Syria
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Lee KE, Lim F, Silver ER, Faye AS, Hur C. Impact of COVID-19 on residency choice: A survey of New York City medical students. PLoS One 2021; 16:e0258088. [PMID: 34614004 PMCID: PMC8494369 DOI: 10.1371/journal.pone.0258088] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 09/17/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The Coronavirus disease 2019 (COVID-19) pandemic disrupted medical student education, particularly in New York City (NYC). We aimed to assess the impact of the COVID-19 pandemic on medical students' residency choices. METHODS The authors conducted a cross-sectional survey of medical students in all years of study at four NYC medical schools (Columbia, Cornell, NYU, and SUNY Downstate). The survey was fielded from 19 Aug 2020 to 21 Sep 2020. Survey questions included items assessing COVID-19 impact on residency choices, personal impact of COVID-19, residency/specialty choices, and factors influencing these choices. RESULTS A total of 2310 students received the survey, with 547 (23.7%) providing partial responses and 212 (9.2%) providing valid responses for our primary analysis. 59.0% of participants thought that COVID-19 influenced their choice of residency/specialty, with 0.9% saying the influence was to a great extent, 22.2% to some extent, and 35.8% very little. On multivariable analysis, factors that were independently associated with COVID-19 impacting residency choice included low debt ($1 to $99,999: adjOR 2.23, 95%CI 1.02-5.03) compared with no debt and Other race/ethnicity (adjOR 0.26, 95%CI 0.10-0.63) compared with White race/ethnicity. On secondary analysis of all participants answering survey items for logistic regression regardless of survey completion, direct personal impact of COVID-19 was significantly associated with COVID-19 impacting specialty choice (adjOR 1.90, 95%CI 1.04-3.52). Moreover, 24 students (11.6%) reported a change in their top residency choice from before to during/after COVID-19, citing concerns about frontline work, work-life balance, and risk of harm. CONCLUSIONS Our study found that 3 in 5 (59.0%) participants felt that COVID-19 impacted their residency choice, with 11.6% of respondents explicitly changing their top specialty choice. Investigating the impact of the pandemic on medical student residency considerations is crucial to understand how medical career outlooks may change in the future.
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Affiliation(s)
- Kate E. Lee
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Francesca Lim
- Department of Medicine, Division of General Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States of America
| | - Elisabeth R. Silver
- Department of Psychological Sciences, Rice University, Houston, TX, United States of America
| | - Adam S. Faye
- Division of Gastroenterology & Hepatology, New York University Langone Health, New York, NY, United States of America
| | - Chin Hur
- Department of Medicine, Division of General Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States of America
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Kurowecki D, Lee SY, Monteiro S, Finlay K. Resident Physicians' Perceptions of Diagnostic Radiology and the Declining Interest in the Specialty. Acad Radiol 2021; 28:261-270. [PMID: 32089466 DOI: 10.1016/j.acra.2020.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES The relative competitiveness of radiology and the number of first-choice applicants to diagnostic radiology have steadily declined over the past decade. The purpose of this study was to identify factors contributing to the declining interest in diagnostic radiology as a career and to explore factors affecting specialty choice. MATERIALS AND METHODS A retrospective survey was distributed to resident physicians at a single academic center between July and August 2017. Participants identified factors affecting career choice and evaluated level of agreement with statements regarding radiology using 5-point Likert scales. Higher scores indicated stronger agreement. RESULTS One hundred and fifty-two resident physicians from Canada participated (21.5% response rate): 20 radiology and 132 nonradiology. Of the total, 27% were registered in postgraduate year (PGY) 1, 23% in PGY 2, 15% in PGY 3, 19% in PGY 4, and 16% in PGY 5, or above. Sixty-one percent of the respondents self-reported as female, 34% as male, and 5% as other/unknown. Of those in radiology, 40% self-reported as female, 55% as male, and 5% as other/unknown, compared to 64% female, 31% male, and 5% other/unknown in other specialties. Regardless of specialty, positive clinical/mentoring experiences strongly affected career choice. Radiology residents were attracted to diverse pathology (M = 4.5) and positive staff/resident interactions (M = 4.4). Nonradiology residents were deterred by lack of patient contact (M = 3.9) and dark work environment (M = 3.6). Resident physicians who had applied to radiology were more likely to report positive mentorship during medical school, disagree that technology will replace radiologists, and desire a higher income specialty (Wald = 56.6, p < 0.001). More recent graduates showed a higher level of concern regarding the potential negative impact of technology and outsourcing on the profession (F (3, 189) = 2.6, p = 0.05). Several trainees (21%) considered radiology, but lacked mentorship (52%) and identified job market concerns (29%). CONCLUSION More recent graduates are relatively more concerned about technology replacing radiologists, and radiology applicants have less concern about artificial intelligence replacing radiologists. As positive interactions with radiologists and mentorship are key influencers, our results advocate for early training exposure and reinforcement regarding the positive outlook of the profession.
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O’Sullivan B, McGrail M, Gurney T, Martin P. A Realist Evaluation of Theory about Triggers for Doctors Choosing a Generalist or Specialist Medical Career. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228566. [PMID: 33218189 PMCID: PMC7699208 DOI: 10.3390/ijerph17228566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 01/29/2023]
Abstract
There is a lack of theory about what drives choice to be a generalist or specialist doctor, an important issue in many countries for increasing primary/preventative care. We did a realist evaluation to develop a theory to inform what works for whom, when and in what contexts, to yield doctors’ choice to be a generalist or specialist. We interviewed 32 Australian doctors (graduates of a large university medical school) who had decided on a generalist (GP/public health) or specialist (all other specialties) career. They reflected on their personal responses to experiences at different times to stimulate their choice. Theory was refined and confirmed by testing it with 17 additional doctors of various specialties/career stages and by referring to wider literature. Our final theory showed the decision involved multi-level contextual factors intersecting with eight triggers to produce either a specialist or generalist choice. Both clinical and place-based exposures, as well as attributes, skills, norms and status of different fields affected choice. This occurred relative to the interests and expectations of different doctors, including their values for professional, socio-economic and lifestyle rewards, often intersecting with issues like gender and life stage. Applying this theory, it is possible to tailor selection and ongoing exposures to yield more generalists.
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Affiliation(s)
- Belinda O’Sullivan
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
- Correspondence: ; Tel.: +61-4-2740-5030
| | - Matthew McGrail
- Faculty of Medicine, The University of Queensland Rural Clinical School, 78 on Canning St, Rockhampton 4700, Queensland, Australia;
| | - Tiana Gurney
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
| | - Priya Martin
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
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Saito H, Tanimoto T, Kami M, Suzuki Y, Morita T, Morita M, Yamamoto K, Shimada Y, Tsubokura M, Endo M. New physician specialty training system impact on distribution of trainees in Japan. Public Health 2020; 182:143-150. [PMID: 32305513 DOI: 10.1016/j.puhe.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/13/2020] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The problem of uneven distribution of medical services and inequitable distribution of physicians is drawing much attention worldwide. Revealing how changes in the specialty training system in Japan have affected the distribution of doctors could help us understand this problem. In 2018, a new and standardized specialty training system was implemented by the Japanese Medical Specialty Board, which is recognized by the Ministry of Health, Labor and Welfare. The purpose of this study was to investigate how this new system has affected the geographical distribution of doctors commencing specialty training (trainees) and choice of specialty in Japan. STUDY DESIGN Retrospective observational study. METHODS The change in the number of trainees between the control period (2012-2014) and 2018 was investigated, taking into account the prefecture and specialty selected. Population, the proportion of residents aged 65 years or older (aging rate), and the total number of overall doctors in each prefecture were considered as the background characteristics of each prefecture. We created a Lorenz curve and calculated the Gini coefficient for the distribution of trainees. RESULTS In 2018, the number of trainees per 100,000 population increased to 6.6 nationwide compared with 5.5 during the control period. The number of trainees per 100,000 population in 2018 increased in prefectures with a large population of ≧ 2,000,000, a low aging rate (<27%), and a high doctor density (≧ 250 doctors per 100,000 population). The Gini coefficient showed an increase to 0.226 in 2018 compared with only 0.160 during the control period. CONCLUSIONS After the implementation of the new training system, there was an increase in the number of doctors enrolling in specialty programs, and the specialties other than internal medicine and surgery have attracted more trainees. Inequality in the distribution of doctors between urban and rural prefectures worsened. This indicates the need to explore new ways of balancing distribution while maintaining optimal opportunities for specialist training.
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Affiliation(s)
- H Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
| | - T Tanimoto
- Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan
| | - M Kami
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Y Suzuki
- Department of Obstetrics and Gynecology, Tone Central Hospital, Numata, Gunma, Japan
| | - T Morita
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - M Morita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - K Yamamoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Y Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
| | - M Tsubokura
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - M Endo
- Support Office for Medical Education and Trainings, Sendai Kousei Hospital, Sendai, Miyagi, Japan
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O'Sullivan BG, McGrail MR. Effective dimensions of rural undergraduate training and the value of training policies for encouraging rural work. MEDICAL EDUCATION 2020; 54:364-374. [PMID: 32227376 DOI: 10.1111/medu.14069] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 05/05/2023]
Abstract
CONTEXT The implementation of rural undergraduate medical education can be improved by collecting national evidence about the aspects of these programmes that work well and the value of investing in national policies. OBJECTIVES This study aimed to explore how different durations, degree of remoteness and number of rural undergraduate medical training placements relate to working rurally, and to investigate differences after the introduction of formal national training policies that fund short- and long-term rural training experiences for medical students. METHODS A cohort of 6510 Australian-trained doctors who completed the Medicine in Australia: Balancing Employment and Life survey recalled their participation in rural undergraduate medical training. Responses were categorised by duration, remoteness as defined by the Modified Monash Model levels 3-4 and 4-7 compared with 1, and total number of placements. Multivariate regression was used to test associations with working rurally in 2017, and differences between cohorts of students who graduated pre- and post-2000, of which the latter were exposed to formal national training policies. RESULTS Any rural undergraduate training was associated with working rurally (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3-1.9) with incrementally stronger associations for longer duration (>1 year: OR 3.0, 95% CI 2.3-4.0), greater remoteness (OR 1.8, 95% CI 1.5-2.1) and three placements (OR 2.4, 95% CI 1.9-3.0) compared with none. Rural background (OR 2.6, 95% CI 2.3-3.0) and general practice (OR 2.6, 95% CI 2.2-2.9) were independently associated with working rurally; being female was negatively associated with rural work (OR 0.7, 95% CI 0.6-0.8). The cohort of doctors who trained in a period when national rural training policies had been implemented included more graduates with a rural background and experience of undergraduate rural training but returned equivalent proportions of rural doctors to pre-policy cohorts, and included proportionally more women and fewer general practitioners. CONCLUSIONS Rural undergraduate training should focus on multiple dimensions of duration, remoteness and number of rural undergraduate training experiences to grow the rural medical workforce. Formal national rural training policies may be an important part of the broader system for rural workforce development, but they rely on the uptake of general practice and the participation of female doctors in rural medicine.
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Affiliation(s)
- Belinda G O'Sullivan
- Rural Clinical School, University of Queensland, Toowoomba DC, Queensland, Australia
| | - Matthew R McGrail
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
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Russo G, Cassenote AJF, Guilloux AGA, Scheffer MC. The role of private education in the selection of primary care careers in low and middle-income countries. Findings from a representative survey of medical residents in Brazil. HUMAN RESOURCES FOR HEALTH 2020; 18:11. [PMID: 32066457 PMCID: PMC7027019 DOI: 10.1186/s12960-020-0456-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Primary health care (PHC) doctors' numbers are dwindling in high- as well as low-income countries, which is feared to hamper the achievement of Universal Health Coverage goals. As a large proportion of doctors are privately educated and private medical schools are becoming increasingly common in middle-income settings, there is a debate on whether private education represents a suitable mean to increase the supply of PHC physicians. We analyse the intentions to practice of medical residents in Brazil to understand whether these differ for public and private schools. METHODS Drawing from the literature on the selection of medical specialties, we constructed a model for the determinants of medical students' intentions to practice in PHC, and used secondary data from a nationally representative sample of 4601 medical residents in Brazil to populate it. Multivariate analysis and multilevel cluster models were employed to explore the association between perspective physicians' choice of practice and types of schools attended, socio-economic characteristics, and their values and opinions on the profession. RESULTS Only 3.7% of residents in our sample declared an intention to practice in PHC, with no significant association with the public or private nature of the medical schools attended. Instead, having attended a state secondary school (p = 0.028), having trained outside Brazil's wealthy South East (p < 0.001), not coming from an affluent family (p = 0.037), and not having a high valuation of career development opportunities (p < 0.001) were predictors of willingness to practice in PHC. A low consideration for quality of life, for opportunities for treating patients, and for the liberal aspects of the profession were also associated with future physicians' intentions to work in primary care (all p < 0.001). CONCLUSIONS In Brazil, training in public or private medical schools does not influence the intention to practice in PHC. But students from affluent backgrounds, with private secondary education, and graduating in the rich South East were found to be overrepresented in both types of training institutions, and this is what appears to negatively impact the selection of PHC careers. With a view to increasing the supply of PHC practitioners in middle-income countries, policies should focus on opening medical schools in rural areas and improving access for students from disadvantaged backgrounds.
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Affiliation(s)
- Giuliano Russo
- Institute of Population Health Sciences, Queen Mary University of London, 58 Turner street, E1 2AB, London, United Kingdom.
| | - Alex J Flores Cassenote
- Departamento da Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, CEP:01246-903, Av. Dr Arnaldo, 455, São Paulo, Brazil
| | - Aline G Alves Guilloux
- Departamento da Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, CEP:01246-903, Av. Dr Arnaldo, 455, São Paulo, Brazil
| | - Mário César Scheffer
- Departamento da Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, CEP:01246-903, Av. Dr Arnaldo, 455, São Paulo, Brazil
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Lefebvre C, Hartman N, Tooze J, Manthey D. Determinants of medical specialty competitiveness. Postgrad Med J 2019; 96:511-514. [PMID: 31780597 DOI: 10.1136/postgradmedj-2019-137160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although the concept of medical specialty competitiveness may seem intuitive, there are very little existing empirical data on the determinants of specialty competitiveness in USA. An understanding of the determinants of specialty competitiveness may inform career choices among students and their advisors. Specialty competitiveness correlates with availability and appeal. METHODS This narrative review examines 2019 National Resident Matching Program (NRMP) data and the existing literature to define the determinants of specialty competitiveness. A statistical analysis of key elements of the 2019 NRMP data was performed. RESULTS Using US senior applicant fill rate as a measure of competitiveness, medical specialty competitiveness follows general principles of supply and demand. The demand, or appeal, of a specialty correlates with several factors, including salary, prestige and lifestyle. Salary correlates strongly with US senior fill rate (r=0.78, p=0.001). Relatively few positions are available for the most competitive specialties in the NRMP match. The negative correlation between US senior fill rate and position availability is also strong (r=-0.85; p<0.0001). CONCLUSION A 'competitive specialty' correlates strongly with high earnings potential and limited position availability. In an ideal world, a student's pursuit of a medical specialty should be guided by interest, qualifications and ability to succeed in that field. However, students must contend with the realities of competition created by the residency matching system.
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Affiliation(s)
- Cedric Lefebvre
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas Hartman
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Janet Tooze
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David Manthey
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Wasserstrum Y, Magnezi R, Tamir O, Koren S, Lotan D, Afek A. Self-reported influence of monetary grants in the choice of a medical residency in remote or under-served areas. Isr J Health Policy Res 2019; 8:1. [PMID: 30764867 PMCID: PMC6376660 DOI: 10.1186/s13584-018-0272-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate the effect of monetary grants on young physicians' choice of remote or rural hospital-based practice. BACKGROUND In late 2011, The Israeli Ministry of Health attempted to address a severe physician maldistribution, which involved severe shortages in remotely-located institutions (RLI). The policy intervention included offering monetary grants to residents who chose a residency program in a RLI. METHODS A total of 222 residents from various disciplines were recruited; 114 residents from RLI and 108 residents from central-located institutions (CLI), who began their residency during 2012-2014. Participants were surveyed on demographic, academic and professional data, and on considerations in the choice of residency location. RESULTS Residents in RLI attributed significantly more importance to the grant in their decision-making process than did residents from CLI. This effect remained significant in a multivariate model (OR 1.65, 95% CI 1.20-2.27, p = 0.002). The only parameter significantly associated with attributing importance to the grant was older age (OR 1.09, 95% CI 1.00-1.19, p = 0.049). CONCLUSION The choice of a RLI for residency may be influenced by monetary grants. This is consistent with real-life data showing an increase in medical staffing in these areas during the program's duration. Further studies are needed to determine causality and physical practicality of such programs.
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Affiliation(s)
- Yishay Wasserstrum
- Internal Medicine Department "T", Chaim Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel. .,Department of Management, Bar Ilan University, Ramat Gan, Israel.
| | - Racheli Magnezi
- Department of Management, Bar Ilan University, Ramat Gan, Israel
| | - Ofer Tamir
- Baruch Padeh Medical Center in Poria, Tiberias, Israel
| | - Stav Koren
- Goldman School of Medicine, Ben Gurion University, Be'er Sheva, Israel
| | - Dor Lotan
- Internal Medicine Department "T", Chaim Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel
| | - Arnon Afek
- Internal Medicine Department "T", Chaim Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ram R, Jumper H, Lensing SY, Tang JL, Deloney LA, Kenney PJ. Understanding Gender Differences Among Medical Students When Choosing Radiology as a Medical Specialty. Acad Radiol 2018. [DOI: 10.1016/j.acra.2018.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ramos P, Alves H. Doctors' career choices in health systems constrained by national medical exams: A discrete choice experiment. Int J Health Plann Manage 2018; 33:e1211-e1224. [PMID: 30091465 DOI: 10.1002/hpm.2608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/05/2018] [Indexed: 11/10/2022] Open
Abstract
Previous studies that addressed factors influencing junior doctors' career decisions have failed to consider that the market for medical specialty is regulated and doctors are not always able to pursue their career of choice. There is the concern that the National Medical Exam that doctors have to take in many countries conditions their career choices and is behind the low efficacy of policies for retaining doctors in rural areas. In this paper, we use data from a Discrete Choice Experiment applied to a large sample of Portuguese junior doctors (N = 503) who had already taken their Medical Exam but had not chosen their medical specialty yet. We show that the exam score is de facto a strong predictor for (different) job preferences, but only for doctors who are amongst the highest and the lowest exam scores. For all others-almost half of our sample-geographical attachment (having lived or studied in rural areas or in metropolis) is more relevant in determining specialization decisions. Having a good work-life balance, specially amongst female physicians, is also an important determinant of specialty choice. Using latent-class analysis may help policymakers profiling different groups of doctors and tailoring incentive packages according to their characteristics.
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Affiliation(s)
- Pedro Ramos
- Diretoria Clínica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, University of São Paulo, São Paulo, Brazil.,Faculty of Medicine of the University of Porto, University of Porto, Porto, Portugal
| | - Hélio Alves
- Faculty of Medicine of the University of Porto, University of Porto, Porto, Portugal
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Vo A, McLean L, McInnes MD. Medical specialty preferences in early medical school training in Canada. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:400-407. [PMID: 29140793 PMCID: PMC5694695 DOI: 10.5116/ijme.59f4.3c15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 10/28/2017] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To understand what medical students consider when choosing their specialty, prior to significant clinical exposure to develop strategies to provide adequate career counseling. METHODS A cross-sectional study was performed by distributing optional questionnaires to 165 first-year medical students at the University of Ottawa in their first month of training with a sample yield of 54.5% (n=90). Descriptive statistics, analysis of variance, Spearman's rank correlation, Cronbach's alpha coefficient, Kaiser-Meyer-Olkin Measure, and exploratory factor analyses were used to analyze the anonymized results. RESULTS "Job satisfaction", "lifestyle following training" and, "impact on the patient" were the three highest rated considerations when choosing a specialty. Fifty-two and seventeen percent (n=24) and 57.89% (n=22) of males and females ranked non-surgical specialties as their top choice. Student confidence in their specialty preferences was moderate, meaning their preference could likely change (mean=2.40/5.00, SD=1.23). ANOVA showed no significant differences between confidence and population size (F(2,86)=0.290, p=0.75) or marital status (F(2,85)=0.354, p=0.70) in both genders combined. Five underlying factors that explained 44.32% of the total variance were identified. Five themes were identified to enhance career counseling. CONCLUSIONS Medical students in their first month of training have already considered their specialty preferences, despite limited exposure. However, students are not fixed in their specialty preference. Our findings further support previous results but expand what students consider when choosing their specialty early in their training. Medical educators and administrators who recognize and understand the importance of these considerations may further enhance career counseling and medical education curricula.
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Affiliation(s)
- Anthony Vo
- Department of Diagnostic Radiology, University of Alberta, Canada
| | - Laurie McLean
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Canada
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Wasserstrum Y, Magnezi R, Tamir O, Koren S, Lotan D, Afek A. The role of direct single monetary grants in residents' choice of field of residency. MEDICAL TEACHER 2017; 39:548-554. [PMID: 28281835 DOI: 10.1080/0142159x.2017.1297891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND In an attempt to address severe medical manpower shortages in several medical disciplines, the Israeli Ministry of Health offered grants to residents who chose one of these fields. METHODS A total of 220 residents from various disciplines were surveyed on demographic, academic, and professional data, and asked to rank considerations in the choice of their field of residency. RESULTS Residents in targeted fields attributed significantly more importance to the grant in their decision-making process (U = 3704.5, p < 0.001). This effect remained significant in a multivariate model (OR 1.67, 95%CI 1.32-2.10, p < 0.001). Higher age (OR 1.15, 95%CI 1.01-1.31, p = 0.031) and attribution of significance to the working conditions compared to other residency fields (OR 1.69, 95%CI 1.23-2.32, p = 0.001) were significantly associated with receptivity toward the grant in a multivariate analysis. DISCUSSION Receptivity toward the offered grants correlated with real-life data shows a rise in physician in these fields, and the weak association between such receptivity and most variables tested may suggest that the grants were perceived as a property of the specific choice rather than a special bonus. CONCLUSIONS Grants may be useful in diverting medical manpower. Further analysis and modeling are required to determine causal relationship and budgetary feasibility.
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Affiliation(s)
- Yishay Wasserstrum
- a Department of Management , Bar-Ilan University , Ramat-Gan , Israel
- b Internal Medicine department "T" , Chaim Sheba Medical Center in Tel-Ha'Shomer , Ramat-Gan , Israel
| | - Racheli Magnezi
- a Department of Management , Bar-Ilan University , Ramat-Gan , Israel
| | - Ofer Tamir
- c Management , Baruch-Padeh Medical Center in Poria , Tiberias , Israel
| | - Stav Koren
- d Goldman School of medicine, Ben-Gurion University , Be'er-Sheva , Israel
| | - Dor Lotan
- b Internal Medicine department "T" , Chaim Sheba Medical Center in Tel-Ha'Shomer , Ramat-Gan , Israel
| | - Arnon Afek
- e Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
- f Israel Ministry of Health , Jerusalem , Israel
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Harris JE, Lopez-Valcarcel BG, Barber P, Ortún V. Allocation of Residency Training Positions in Spain: Contextual Effects on Specialty Preferences. HEALTH ECONOMICS 2017; 26:371-386. [PMID: 26880315 DOI: 10.1002/hec.3318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
In Spain's 'MIR' system, medical school graduates are ranked by their performance on a national exam and then sequentially choose from the available residency training positions. We took advantage of a unique survey of participants in the 2012 annual MIR cycle to analyze preferences under two different choice scenarios: the residency program actually chosen by each participant when it came her turn (the 'real') and the program that she would have chosen if all residency training programs had been available (the 'counterfactual'). Utilizing conditional logit models with random coefficients, we found significant differences in medical graduates' preferences between the two scenarios, particularly with respect to three specialty attributes: work hours/lifestyle, prestige among colleagues, and annual remuneration. In the counterfactual world, these attributes were valued preferentially by those nearer to the top, while in the real world, they were valued preferentially by graduates nearer to the bottom of the national ranking. Medical graduates' specialty preferences, which we conclude, are not intrinsically stable but depend critically on the 'rules of the game'. The MIR assignment system, by restricting choice, effectively creates an externality in which those at the bottom, who have fewer choices, want what those at the top already have. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Beatriz G Lopez-Valcarcel
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Patricia Barber
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Vicente Ortún
- Faculty of Economic and Business Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Lopez-Valcarcel BG, Barber P. Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:13-21. [PMID: 27461007 DOI: 10.1007/s40258-016-0263-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This paper reviews economic and medical research publications to determine the extent to which the measures applied in Spain to control public health spending following the economic and financial crisis that began in 2008 have affected healthcare utilization, health and fairness within the public healthcare system. The majority of the studies examined focus on the most controversial cutbacks that came into force in mid-2012. The conclusions drawn, in general, are inconclusive. The consequences of this new policy of healthcare austerity are apparent in terms of access to the system, but no systematic effects on the health of the general population are reported. Studies based on indicators of premature mortality, avoidable mortality or self-perceived health have not found clear negative effects of the crisis on public health. The increased demands for co-payment provoked a short-term cutback in the consumption of medicines, but this effect faded after 12-18 months. No deterioration in the health of immigrants after the onset of the crisis was unambiguously detected. The impact of the recession on the general population in terms of diseases associated with mental health is well documented; however, the high levels of unemployment are identified as direct causes. Therefore, social policies rather than measures affecting the healthcare system would be primarily responsible. In addition, some health problems have a clear social dimension, which seems to have become more acute during the crisis, affecting in particular the most vulnerable population groups and the most disadvantaged social classes, thus widening the inequality gap.
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Affiliation(s)
- Beatriz G Lopez-Valcarcel
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus Tafira, 35320, Las Palmas de Gran Canaria, Spain.
| | - Patricia Barber
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus Tafira, 35320, Las Palmas de Gran Canaria, Spain
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Mofolo N, Botes J. An evaluation of factors influencing perceptual experiences and future plans of final-year medical interns in the Free State, 2013–2014. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2016.1225421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ng-Sueng LF, Vargas-Matos I, Mayta-Tristán P, Pereyra-Elías R, Montenegro-Idrogo JJ, Inga-Berrospi F, Ancalli F, Bonilla-Escobar F, Diaz-Velez C, Gutierrez-Quezada E, Gomez-Alhach J, Muñoz-Medina CE, Sanchez-Pozo A, Vidal M. Gender Associated with the Intention to Choose a Medical Specialty in Medical Students: A Cross-Sectional Study in 11 Countries in Latin America. PLoS One 2016; 11:e0161000. [PMID: 27519055 PMCID: PMC4982605 DOI: 10.1371/journal.pone.0161000] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction The selection of a medical specialty has been associated with multiple factors, such as personal preferences, academic exposure, motivational factors and sociodemographic factors, such as gender. The number of women in the medical field has increased in recent years. In Latin America, we have not found any studies that explore this relationship. Objective To determine whether there is an association between gender and the intention to choose a medical specialty in medical students from 11 countries in Latin America. Methods Secondary analysis of the Collaborative Working Group for the Research of Human Resources for Health (Red-LIRHUS) data; a multi-country project of students in their first year and fifth year of study, from 63 medical schools in 11 Latin American countries. All students who referred intention to choose a certain medical specialty were considered as participants. Results Of the 11073 surveyed students, 9235 indicated the name of a specific specialty. The specialties chosen most often in the fifth year were General Surgery (13.0%), Pediatrics (11.0%), Internal Medicine (10.3%) and Obstetrics/Gynecology (9.0%). For women, the top choices were Pediatrics (15.8%), Obstetrics/Gynecology (11.0%), Cardiology (8.7%), General Surgery (8.6%), and Oncology (6.4%). In the adjusted analysis, the female gender was associated with the choice of Obstetrics/Gynecology (RP: 2.75; IC95%: 2.24–3.39); Pediatric Surgery (RP: 2.19; IC95%: 1.19–4.00), Dermatology (RP: 1.91; IC95%:1.24–2.93), Pediatrics (RP: 1.83; IC95%: 1.56–2.17), and Oncology (RP: 1.37; IC95%: 1.10–1.71). Conclusions There is an association between the female gender and the intention to choose Obstetrics/Gynecology, Pediatrics, Pediatric Surgery, Dermatology, and Oncology. We recommend conducting studies that consider other factors that can influence the choice of a medical specialty.
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Affiliation(s)
- Luis Fernando Ng-Sueng
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
- Sociedad Científica Estudiantes de Medicina UPC, Lima, Perú
| | - Iván Vargas-Matos
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Percy Mayta-Tristán
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
- * E-mail:
| | | | | | | | - Felix Ancalli
- Universidad Nacional Jorge Basadre Grohmann, Tacna, Perú
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Zener R, Lee SY, Visscher KL, Ricketts M, Speer S, Wiseman D. Women in Radiology: Exploring the Gender Disparity. J Am Coll Radiol 2016; 13:344-50.e1. [DOI: 10.1016/j.jacr.2015.10.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/07/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
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Ogun OA. Encouraging Subspecialty Practice by Constructively Influencing Trainees Early in their Careers Will Improve Advocacy for Neuro-Ophthalmology among Nigerian Ophthalmologists. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2016; 3:10.4137_JMECD.S40794. [PMID: 29349319 PMCID: PMC5736284 DOI: 10.4137/jmecd.s40794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/06/2016] [Accepted: 10/09/2016] [Indexed: 06/07/2023]
Abstract
This study was conducted to assess the current knowledge, attitude, and perception of Nigerian ophthalmologists toward neuro-ophthalmology; identify barriers to the uptake of neuro-ophthalmology as a desired subspecialty; and make recommendations to improve interest in neuro-ophthalmology training. This was a cross-sectional survey of ophthalmology consultants and trainees from the six geopolitical zones of Nigeria, who were attending a national ophthalmology conference. All consenting respondents voluntarily completed a validated self-administered questionnaire. There were 107 respondents comprising 56 males and 51 females. Majority (54.2%) of respondents were aged 40 years and younger. Almost half (47.8%) worked at tertiary level, public health institutions. Only 10.3% worked in private practice. Neuro-ophthalmology exposure was short and occurred mainly during residency (65.7%), while 15% had no exposure at all. Most (80.4%) indicated only nominal interest in neuro-ophthalmology, while only 4.6% indicated a desire to specialize in the field. Financial constraint was the main obstacle to the pursuit of subspecialty training. A total of 86% of respondents admitted that full (34%) or partial (52%) Funding would motivate them to pursue the training. Among respondents desiring part sponsorship, more than half were willing to augment such sponsorship with personal funds. In conclusion, career interest in neuro-ophthalmology is very low among Nigerian ophthalmologists. Late and limited exposure to neuro-ophthalmology during medical training may be contributing factors. Early exposure to neuro-ophthalmology during medical school rotations, coupled with the provision of sponsored subspecialty training opportunities, will serve to increase enrollment in the field.
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Affiliation(s)
- Olufunmilola A. Ogun
- Honorary Consultant (Neuro-Ophthalmology and General Ophthalmology), Department of Ophthalmology, College of Medicine, University of Ibadan
- University College Hospital, Ibadan, Nigeria
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Smith F, Lambert TW, Goldacre MJ. Factors influencing junior doctors' choices of future specialty: trends over time and demographics based on results from UK national surveys. J R Soc Med 2015; 108:396-405. [PMID: 26432808 DOI: 10.1177/0141076815599674] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To study trends in factors influencing junior doctors' choice of future specialty. DESIGN Respondents were asked whether each of 15 factors had a great deal of influence on their career choice, a little influence or no influence on it. Percentages are reported of those who specified that a factor had a great deal of influence on their career choice. SETTING UK. PARTICIPANTS A total of 15,765 UK-trained doctors who graduated between 1999 and 2012. MAIN OUTCOME MEASURES Questions about career choices and factors which may have influenced those choices, in particular comparing doctors who qualified in 2008-2012 with those who qualified in 1999-2002. RESULTS Enthusiasm for and commitment to the specialty was a greater influence on career choice in the 2008-2012 qualifiers (81%) than those of 1999-2002 (64%), as was consideration of their domestic circumstances (43% compared with 20%). Prospects for promotion were less important to recent cohorts (16%) than older cohorts (21%), as were financial prospects (respectively, 10% and 14%). Domestic circumstances and working hours were considered more important, and financial prospects less important, by women than men. Inclination before medical school was rated as important by 41% of doctors who were over 30 years old, compared with 13% of doctors who were under 21, at the time of starting medical school. CONCLUSIONS The increasing importance of both domestic circumstances and enthusiasm for their specialty choice in recent cohorts suggest that today's young doctors prize both work-life balance and personal fulfilment at work more highly than did their predecessors. The differences in motivations of older and younger generations of doctors, men and women, and doctors who start medical school relatively late are worthy of note.
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Affiliation(s)
- Fay Smith
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX7 3LF, UK
| | - Trevor W Lambert
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX7 3LF, UK
| | - Michael J Goldacre
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX7 3LF, UK
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Bataller-Bassols A, Terán Díez M, Romaguera Piñol A, Camps I Fondevila B. [Professional situation of young medical specialists at the end of their residency in Barcelona]. Med Clin (Barc) 2015; 144:230-1. [PMID: 24994005 DOI: 10.1016/j.medcli.2014.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Adriana Bataller-Bassols
- Servicio de Anestesiología, Hospital Quirón-Teknon, Barcelona, España; Junta del Col·legi Oficial de Metges de Barcelona, Barcelona, España
| | - Mónica Terán Díez
- Sección MIR del Col·legi Oficial de Metges de Barcelona, Barcelona, España; Medicina Familiar y Comunitaria, Centre d'Atenció Primària Maragall, Barcelona, España
| | - Anna Romaguera Piñol
- Sección MIR del Col·legi Oficial de Metges de Barcelona, Barcelona, España; Psiquiatría, Fundación para la Investigación y Docencia María Angustias Giménez (FIDMAG), Barcelona, España
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Scott A, Joyce CM. The future of medical careers. Med J Aust 2014; 201:82-3. [PMID: 25045978 DOI: 10.5694/mja13.00063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/05/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia.
| | - Catherine M Joyce
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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González Lopez-Valcarcel B, Ortún V, Barber P, Harris JE. [Important differences between faculties of medicine. Implications for family and community medicine]. Aten Primaria 2014; 46:140-6. [PMID: 24238767 PMCID: PMC6985598 DOI: 10.1016/j.aprim.2013.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/24/2013] [Accepted: 08/29/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine if there are significant differences between universities in the proclivity to choose Family and Community Medicine (FCM), given the constraints imposed by the number of choice. To test the hypothesis that the Schools of Medicine that have the FCM as a compulsory subject in the degree (3 of 27) had the highest preference for this specialty. DESIGN Observational study on the data file of all the individuals taking the MIR examination between 2003 and 2011. LOCATION Spain. PARTICIPANTS All those who sat the examinations called by MIR 2003-2011. MAIN MEASUREMENTS Position in the ranking of each candidate, elected position (specialty and center), post code of residence, sex, nationality and university in which they studied, and post code location for the residence chosen. RESULTS The percentage electing FCM is highly correlated with the position in the ranking: 8% of graduates for the 'best' college, 46% for the worst. Very noticeable and consistent differences in the preparation for the MIR among the 27 medical schools. Ranking in the exam, female and foreigner, help predict the choice of FCM. The FCM compulsory curriculum from three universities does not seem to exert any influence. CONCLUSIONS The convenient yardstick competition between the schools of medicine, FCM in their curriculum and the emphasis on the most attractive attributes of the specialty can contribute to the necessary renewal of FCM.
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Affiliation(s)
- Beatriz González Lopez-Valcarcel
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Vicente Ortún
- Centre de Recerca en Economia i Salut (CRES) y Departamento de Economía y Empresa, Universidad Pompeu Fabra, Barcelona, España.
| | - Patricia Barber
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Jeffrey E Harris
- Departamento de Economía, Massachusetts Institute of Technology, Cambridge, Massachusetts, Estados Unidos; Providence Community Health Centers, Providence, Rhode Island, Estados Unidos
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