Medical graduates' early career choices of specialty and their eventual specialty destinations: UK prospective cohort studies.
Ontology highlight
ABSTRACT: Objective
To report on doctors' early choices of specialty at selected intervals after qualification, and eventual career destinations.Design
Questionnaire surveys.Setting
United Kingdom.Participants
Total of 15 759 doctors who qualified in 1974, 1977, 1983, 1993, and 1996, and their career destinations 10 years after graduation.Results
15 759 doctors were surveyed one and three years after graduation and 12 108 five years after graduation. Career preferences at years 1, 3, and 5, and destinations at 10 years, were known for, respectively, 64% (n=10 154), 62% (n=9702), and 61% (n=7429) of the survey population. In the 1993 and 1996 cohorts, career destinations matched with year 1 choices for 54% (1890/3508) of doctors in year 1, 70% (2494/3579) in year 3, and 83% (2916/3524) in year 5. Corresponding results for the earlier cohorts (1974-83) were similar: 53% (3310/6264), 74% (4233/5752), and 82% (2976/3646). The match rates varied by specialty; for example, the rates were consistently high for surgery. Career destinations matched with year 1 choices for 74% (722/982) of doctors who specified a definite (rather than probable or uncertain) specialty choice in their first postgraduate year. About half of those who chose a hospital specialty but did not eventually work in it were working in general practice by year 10.Conclusions
Ten years after qualification about a quarter of doctors were working in a specialty that was different from the one chosen in their third year after graduation. This stayed reasonably constant across graduation cohorts despite the changes in training programmes over time. Subject to the availability of training posts, postgraduate training should permit those who have made early, definite choices to progress quickly into their chosen specialty, while recognising the need for flexibility for those who choose later.
SUBMITTER: Goldacre MJ
PROVIDER: S-EPMC2897977 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:ObjectiveTo report doctors' early career preferences for emergency medicine, their eventual career destinations and factors influencing their career pathways.DesignSelf-administered questionnaire surveys.SettingUnited Kingdom.ParticipantsAll graduates from all UK medical schools in selected graduation years between 1993 and 2015.Main outcome measuresChoices for preferred eventual specialty; eventual career destinations; certainty about choice of specialty; correspondence between early specialty choice for emergency medicine and eventually working in emergency medicine.ResultsEmergency medicine was chosen by 5.6% of graduates of 2015 when surveyed in 2016, and 7.1% of graduates of 2012 surveyed in 2015. These figures represent a modest increase compared with other recent cohorts, but there is no evidence of a sustained long-term trend of an increase. More men than women specified emergency medicine - in 2016 6.6% vs. 5.0%, and in 2015 7.9% vs. 6.5%. Doctors choosing emergency medicine were less certain about their choice than doctors choosing other specialties. Of graduates of 2005 who chose emergency medicine in year 1, only 18% were working in emergency medicine in year 10. Looking backwards, from destinations to early choices, 46% of 2005 graduates working in emergency medicine in 2015 had specified emergency medicine as their choice of eventual specialty in year 1.ConclusionsThere was no substantial increase across the cohorts in choices for emergency medicine. Policy should address how to encourage more doctors to choose the specialty, and to create a future UK health service environment in which those who choose emergency medicine early on do not later change their minds in large numbers.
| S-EPMC7586038 | biostudies-literature
Project description:BackgroundCardiology is one of the most popular of the hospital medical specialties in the UK. It is also a highly competitive specialty in respect of the availability of higher specialty training posts. Our aims are to describe doctors' early intentions about seeking careers in cardiology, to report on when decisions about seeking a career in cardiology are made, to compare differences between men and women doctors in the choice of cardiology, and to compare early career choices with later specialty destinations.MethodsQuestionnaire surveys were sent to all UK medical graduates in selected qualification years from 1974-2009, at 1, 3, 5, 7 and 10 years after graduation.ResultsOne year after graduation, the percentage of doctors specifying cardiology as their first choice of long-term career rose from the mid-1990s from 2.4% (1993 cohort) to 4.2% (2005 cohort) but then fell back to 2.7% (2009 cohort). Men were more likely to give cardiology as their first choice than women (eg 4.1% of men and 1.9% of women in the 2009 cohort). The percentage of doctors who gave cardiology as their first choice of career declined between years one and five after qualification: the fall was more marked for women. 34% of respondents who specified cardiology as their sole first choice of career one year post-graduation were later working in cardiology. 24% of doctors practising as cardiologists several years after qualification had given cardiology as their sole first choice in year one. The doctors' 'domestic circumstances' were a relatively unimportant influence on specialty choice for aspiring cardiologists, while 'enthusiasm/commitment', 'financial prospects', 'experiences of the job so far' and 'a particular teacher/department' were important.ConclusionsCardiology grew as a first preference one year after graduation to 2005 but is now falling. It consistently attracts a higher percentage of men than women doctors. The correspondence between early choice and later destination was not particularly strong for cardiology, and was less strong than that for several other specialties.
| S-EPMC3579736 | biostudies-literature
Project description:BackgroundThe rapidly rising rates of brain diseases due to the growing ageing population and the explosion in treatment options for many neurological conditions increase the demand for neurologists. We report trends in doctors' career choices for neurology; investigate factors driving their choices; and compare doctors' original choices with their specialty destinations.MethodsA multi-cohort, multi-purpose nation-wide study using both online and postal questionnaires collected data on career choice, influencing factors, and career destinations. UK-trained doctors completed questionnaires at one, three, five, and ten years after qualification. They were classified into three groups: graduates of 1974-1983, graduates of 1993-2002, and graduates of 2005-2015.ResultsNeurology was more popular among graduates of 2005-2015 than earlier graduates; however, its attraction for graduates of 2005-2015 doctors reduced over time from graduation. A higher percentage of men than women doctors chose neurology as their first career choice. For instance, among graduates of 2005-2015, 2.2% of men and 1.1% of women preferred neurology as first choice in year 1. The most influential factor on career choice was "enthusiasm for and commitment to the specialty" in all cohorts and all years after graduation. Only 39% who chose neurology in year 1 progressed to become neurologists later. Conversely, only 28% of practicing neurologists in our study had decided to become neurologists in their first year after qualification. By year 3 this figure had risen to 65%, and by year 5 to 76%.ConclusionsCareer decision-making among UK medical graduates is complicated. Early choices for neurology were not highly predictive of career destinations. Some influential factors in this process were identified. Improving mentoring programmes to support medical graduates, provide career counselling, develop professionalism, and increase their interest in neurology were suggested.
| S-EPMC6621943 | biostudies-literature
Project description:BackgroundChanges to the structure of medical training worldwide require doctors to decide on their career specialty at an increasingly early stage after graduation. We studied trends in career choices for surgery, and the eventual career destinations, of UK graduates who declared an early preference for surgery.MethodsPostal questionnaires were sent, at regular time intervals after qualification, to all medical qualifiers from all UK medical schools in selected qualification years between 1974 and 2005. They were sent in the first year after qualification, at year three and five years after qualification, and at longer time intervals thereafter.ResultsResponses were received from 27,749 of 38,280 doctors (73%) at year one, 23,468 of 33,151 (71%) at year three, and 17,689 of 24,870 (71%) at year five. Early career preferences showed that surgery has become more popular over the past two decades. Looking forward from early career choice, 60% of respondents (64% of men, 48% of women) with a first preference for a surgical specialty at year one eventually worked in surgery (p < 0.001 for the male-female comparison). Looking backward from eventual career destinations, 90% of responders working in surgery had originally specified a first choice for a surgical specialty at year one. 'Match' rates between eventual destinations and early choices were much higher for surgery than for other specialties. Considering factors that influenced early specialty choice 'a great deal', comparing aspiring surgeons and aspiring general practitioners (GPs), a significantly higher percentage who chose surgery than general practice specified enthusiasm for the specialty (73% vs. 53%), a particular teacher or department (34% vs. 12%), inclinations before medical school (20% vs. 11%), and future financial prospects (24% vs. 13%); and a lower percentage specified that hours and working conditions had influenced their choice (21% vs. 71%). Women choosing surgery were influenced less than men by their inclinations before medical school or by their future financial prospects.ConclusionsSurgery is a popular specialty choice in the UK. The great majority of doctors who progressed in a surgical career made an early and definitive decision to do so.
| S-EPMC2987756 | biostudies-literature
Project description:BackgroundBased upon student ratings of such factors as predictable work hours and personal time, medical specialties have been identified as lifestyle friendly, intermediate, or unfriendly. Lifestyle friendly programs may be more desirable, more competitive, and for students elected to the Alpha Omega Alpha (AOA) Honor Medical Society, more attainable.ObjectiveThe objective of this study was to evaluate whether AOA students increasingly entered lifestyle friendly residency programs and whether trends in program selection differed between AOA and non-AOA graduates.DesignThis retrospective cohort study examined PGY-2 data from the Association of American Medical Colleges and the 12 allopathic schools in the Associated Medical Schools of New York.ParticipantsData on 1987-2006 graduates from participating schools were evaluated.Main measuresResidency program selection over the 20-year period served as the main outcome measure.Key resultsAOA graduates increasingly entered lifestyle-friendly residencies--from 12.9% in 1987 to 32.6% in 2006 (p?<?0.01). There was also a significant decrease in AOA graduates entering lifestyle unfriendly residencies, from 31.6% in 1987 to 12.6% in 2006 (p?<?0.01). Selection of lifestyle intermediate residencies among AOA graduates remained fairly stable at an average of 53%. Similar trends were found among non-AOA students. However, within these categories, AOA graduates increasingly selected radiology, dermatology, plastic surgery and orthopedics while non-AOA graduates increasingly selected anesthesiology and neurology.ConclusionsWhile lifestyle factors appear to influence residency program selection, AOA graduates differentially were more likely to either choose or attain certain competitive, lifestyle-friendly specialties. Health care reform should be targeted to improve lifestyle and decrease income disparities for specialties needed to meet health manpower needs.
| S-EPMC3235601 | biostudies-literature
Project description:ObjectivesTo examine sex differences in the specialty training recruitment outcomes of UK medical graduates; and whether sex differences were explained by prior academic attainment and previous fitness to practise (FtP) declarations.DesignRetrospective longitudinal cohort study.SettingAdministrative data on entrants to all UK medical schools from the UK Medical Education Database.Participants10 559 doctors (6 155; 58% female) who entered a UK medical school in 2007 or 2008 and were eligible to apply for specialty training by 2015.Primary outcome measureOdds of application, offer and acceptance to any specialty training programme, and on to each of the nine largest training programmes, adjusting for sex, other demographics, prior academic attainment, FtP declaration and medical school.ResultsAcross all specialties, there were no sex differences in applications for specialty training, but women had increased odds of getting an offer (OR=1.40; 95% CI=1.25 to 1.57; p<0.001) and accepting one (OR=1.43; 95% CI=1.19 to 1.71; p<0.001). Seven of the nine largest specialties showed significant sex differences in applications, which remained after adjusting for other factors. In the adjusted models, Paediatrics (OR=1.57; 95% CI=1.01 to 2.46; p=0.046) and general practice (GP) (OR=1.23; 95% CI=1.03 to 1.46; p=0.017) were the only specialties to show sex differences in offers, both favouring women. GP alone showed sex differences in acceptances, with women being more likely to accept (OR=1.34; 95% CI=1.03 to 1.76; p=0.03). Doctors with an FtP declaration were slightly less likely to apply to specialty training overall (OR=0.84; 95% CI=0.71 to 1.00; p=0.048) and less likely to accept an offer to any programme (OR=0.71; 95% CI=0.52 to 0.98; p=0.036), after adjusting for confounders.ConclusionsSex segregation between medical specialties is due to differential application, although research is needed to understand why men are less likely to be offered a place on to GP and Paediatrics training, and if offered GP are less likely to accept.
| S-EPMC6429837 | biostudies-literature
Project description:ObjectivesTo report the self-assessed views of a cohort of medical graduates about the impact of having (or wanting to have) children on their specialty choice and the extent to which their employer was supportive of doctors with children.SettingUnited Kingdom (UK).ParticipantsUK medical graduates of 2002 surveyed by post and email in 2014.ResultsThe response rate was 64.2% (2057/3205). Most respondents were living with a spouse or partner (86%) and, of these, 49% had a medical spouse. Having children, or wanting to have children, had influenced specialty choice for 47% of respondents; for 56% of doctors with children and 29% of doctors without children; for 59% of women and 28% of men; and for 78% of general practitioners compared with 27% of hospital doctors and 18% of surgeons. 42% of respondents regarded the National Health Service as a family-friendly employer, and 64% regarded their specialty as family-friendly. More general practitioners (78%) than doctors in hospital specialties (56%) regarded their specialty as family-friendly, while only 32% of surgeons did so.Of those who had taken maternity/paternity/adoption leave, 49% rated the level of support they had received in doing so as excellent/good, 32% said it was acceptable and 18% said the support had been poor/very poor.ConclusionsHaving children is a major influence when considering specialty choice for many doctors, especially women and general practitioners. Surgeons are least influenced in their career choice by the prospect of parenthood. Almost half of doctors in hospital specialties regard their specialty as family-friendly.
| S-EPMC5629622 | biostudies-literature
Project description:Although medical school programs oriented toward postgraduate specialty training have the potential to reduce the duration and cost of medical school for US medical students, success depends on the ability of students to predict their postgraduate specialties. It is clear that first-year choices are poorly predictive, but it is not known when predictions become sufficiently reliable to support specialty-oriented learning programs. We therefore examined the predictive value of specialty preferences expressed at the ends of the first, second and third years of medical school and asked whether concurrent expressions of confidence in choices improved predictive ability. We also investigated the possibility that discrepancies between predicted and actual postgraduate specialty training were related to scores on an examination of knowledge in basic biomedical sciences required for US medical school graduation (the United States Medical Licensing Examination (USLME) Step 1 examination).We calculated positive and negative predictive values (PPV and NPV, respectively) for specialty choices and the sensitivity and specificity of asking for choices for 634 University of Colorado School of Medicine students who trained in 23 accredited residencies from 2011 through 2015. We examined the effect of confidence in first choices in 609 students, and in 334 students, sought an association between USMLE Step 1 scores and switching from postgraduate training specialties predicted at the end of year 2.The PPV of first choices improved from years 1 through 3. NPV was high throughout. PPVs of year 3 first choices ranged from 79% in Anesthesiology to 95% in Psychiatry. Expressions of confidence in first choices did not improve PPV. Sensitivity of asking for first choices increased with time; specificity was consistently high. USLME Step 1 scores were higher for students who ultimately trained in specialties more competitive than first-choice specialties at the end of year 2.Specialty-oriented learning programs during medical school must accommodate students who change career plans. The PPV of specialty first choices improves each year, but even year 3 predictions can be inaccurate with potential loss of students from specialty-specific programs. USMLE Step 1 scores appeared to affect career plans expressed at the end of year 2.
| S-EPMC5845137 | biostudies-literature
Project description:This study examined the determinants of specialty choice of preresidency medical graduates in southeastern Nigeria.We used a comparative cross-sectional survey of preresidency medical graduates who took the Basic Sciences Examination of the Postgraduate Medical College in Enugu, southeastern Nigeria, in March 2007. Data on participants' demographics and specialty selected, the timing of the decision, and factors in specialty selection were collected using a questionnaire. Data were examined using descriptive and analytical statistics. P < .05 was considered significant.The survey response rate was 90.8% (287 of 316). The sample included 219 men and 68 women, ranging in age from 24 to 53 years and with a mean age of 33.5 ± 1.1 (SD) years. Career choice was more frequently influenced by personal interest (66.6%), career prospects (9.1%), and appraisal of own skills/aptitudes (5.6%), and it was least affected by altruistic motives (1.7%) and influence of parents/relations (1.7%). The respondents selected specialties at different rates: obstetrics and gynecology (22.6%), surgery (19.6%), pediatrics (16.0%), anesthesiology (3.1%), psychiatry (0.3%), and dentistry (0.0%). Most (97.2%) participants had decided on specialty choice by the end of their fifth (of a total 16 years) postgraduate year. The participants significantly more frequently preferred surgery and pediatrics to other disciplines (P < .002, after Bonferroni correction for multiple comparisons).Preresidency medical graduates in southeastern Nigeria were influenced by personal interest, career prospects, and personal skills/aptitude in deciding which specialty training to pursue. The most frequently chosen specialties were surgery and pediatrics. These findings have implications for Nigeria's education and health care policy makers.
| S-EPMC3179211 | biostudies-other
Project description:Specialty choices among medical graduates have undergone changes over time. We aimed to analyze status of otorhinolaryngology as specialty of choice among female medical graduates and factors affecting it. A total of 123 female medical graduates were surveyed during their internship over a period of 1 year in a tertiary-care hospital. Each intern was assessed using a questionnaire at the end of otorhinolaryngology rotation. The survey included nine questions about future career choices with special focus on ENT as a choice for specialization. Questions on choice of specialty, reason for choice, quality of undergraduate teaching and clinical postings were included. The post graduation specialty choices in descending order are Medicine, Pediatrics, Surgery, Obstetrics and Gynecology, Dermatology, Ophthalmology, Radiology, ENT, Anesthesia, Psychiatry followed by Physiology, Anatomy and Biochemistry. Among surgical branches most popular choice was General Surgery followed by Obstetrics and Gynecology, Ophthalmology, ENT and Orthopedics in descending order. Reason for the choice included advice from family and friends. Forty two interns (34.2%) followed advice of senior colleagues, 42 (34.2%) followed advice of relatives in the medical field, 25 (20.3%) took advice of non-medico parents while 14 (11.3%) followed their peer group. Regarding the opinion on the quality of undergraduate teaching and clinical postings, both were rated good by the majority. Otorhinolaryngology is less preferred than other general surgery, Obstetrics and Gynecology and ophthalmology by female medical graduates among surgical disciplines. Possible reasons and ways to improve status of Otorhinolaryngology are discussed.
| S-EPMC5714905 | biostudies-other