Journal of General Internal Medicine

, Volume 24, Issue 8, pp 946–949 | Cite as

Internal Medicine Resident Self-report of Factors Associated with Career Decisions

  • Colin P. WestEmail author
  • Monica M. Drefahl
  • Carol Popkave
  • Joseph C. Kolars
Original Article



Little is known about factors contributing to the career decisions of internal medicine residents.


To evaluate factors self-reported by internal medicine residents nationally as important to their career decisions.


Cross-sectional survey conducted in October of 2005, 2006, and 2007 as part of the national Internal Medicine In-Training Examination (IM-ITE).


Postgraduate year 3 internal medicine residents taking the IM-ITE.


Residents rated the importance of nine factors in their career decisions on 5-point Likert scales. Univariate statistics characterized the distribution of responses. Associations between variables were evaluated using Cochran-Mantel-Haenszel statistics for ordinal data. Multivariate analyses were conducted using logistic regression.


Of 17,044 eligible residents taking the IM-ITE, 14,890 (87.4%) completed the career decision survey questions. Overall, time with family was the factor most commonly reported as of high or very high importance to career decisions (69.6%). Women were more likely to assign greatest importance to family time (OR 1.22, 95% confidence interval 1.12–1.31, p < 0.001) and long-term patient relationships (OR 1.34, 95% confidence interval 1.23–1.46, p < 0.001). Across debt levels, financial considerations were of greatest importance more often for residents owing >$150,000 (OR 1.33, 95% confidence interval 1.09–1.62, p < 0.001). Across specialties, mentor specialty was rated lowest in importance by residents pursuing hospitalist and general internal medicine careers.


Greater attention to factors reported by residents as important to their career decisions may assist efforts to optimize the distribution of physicians across disciplines. In addition to lifestyle and practice considerations, these factors may include mentor specialty. As this factor is less commonly reported as important by residents planning careers in generalist fields, attention to effective mentoring may be an important element of efforts to increase interest in these areas.


career decision career plan ACGME graduate medical education internship and residency 



The authors wish to acknowledge the assistance of George Lonsdorf with the American Board of Internal Medicine in providing data on the number of internal medicine residents in training in 2005–7.

Funding source


Conflicts of Interest

None disclosed.

Supplementary material

11606_2009_1039_MOESM1_ESM.pdf (116 kb)
ESM 1 (PDF 119 kb)


  1. 1.
    Kassebaum DG, Szenas PL. Relationship between indebtedness and the specialty choices of graduating medical students. Acad Med. 1992;67:700–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Kassebaum DG, Szenas PL. Factors influencing the specialty choices of 1993 medical school graduates. Acad Med. 1994;69:164–70.Google Scholar
  3. 3.
    Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA. 2003;290:1173–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Dorsey ER, Jarjoura D, Rutecki GW. The influence of contrallable lifestyle and sex on the specialty choices of graduating US medical students, 1996–2003. Acad Med. 2005;80:791–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Hauer KE, Durning SJ, Kernan WN, et al. Factors associated with medical students’ career choices regarding internal medicine. JAMA. 2008;300:1154–64.PubMedCrossRefGoogle Scholar
  6. 6.
    McDonald FS, West CP, Popkave C, Kolars JC. Educational debt and reported career plans among internal medicine residents. Ann Intern Med. 2008;149:416–20.PubMedGoogle Scholar
  7. 7.
    Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Acad Med. 2005;80:507–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Griffith CH III, Georgesen JC, Wilson JF. Specialty choices of students who actually have choices: the influence of excellent clinical teachers. Acad Med. 2000;75:278–82.PubMedGoogle Scholar
  9. 9.
    Levy BD, Katz JT, Wolf MA, Sillman JS, Handin RI, Dzau VJ. An initiative in mentoring to promote residents’ and faculty members’ careers. Acad Med. 2004;79:845–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Ramanan RA, Taylor WC, Davis RB, Phillips RS. Mentoring matters: mentoring and career preparation in internal medicine residency training. J Gen Intern Med. 2006;21:340–5.PubMedCrossRefGoogle Scholar
  11. 11.
    West CP, Popkave C, Schultz HJ, Weinberger SE, Kolars JC. Changes in career decisions of internal medicine residents during training. Ann Intern Med. 2006;145:774–9.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Colin P. West
    • 1
    • 2
    Email author
  • Monica M. Drefahl
    • 1
  • Carol Popkave
    • 3
  • Joseph C. Kolars
    • 4
  1. 1.Division of General Internal MedicineMayo ClinicRochesterUSA
  2. 2.Division of Biomedical Statistics and InformaticsMayo ClinicRochesterUSA
  3. 3.Research CenterAmerican College of PhysiciansPhiladelphiaUSA
  4. 4.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

Personalised recommendations