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Exploring US internal medicine resident career preferences: a Q-methodology study

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Abstract

Career selection in medicine is a complex and underexplored process. Most medical career studies performed in the U.S. focused on the effect of demographic variables and medical education debt on career choice. Considering ongoing U.S. physician workforce shortages and the trilateral adaptive model of career decision making, a robust assessment of professional attitudes and work-life preferences is necessary. The objective of this study was to explore and define the dominant viewpoints related to career choice selection in a cohort of U.S. IM residents. We administered an electronic Q-sort in which 218 IM residents sorted 50 statements reflecting the spectrum of opinions that influence postgraduate career choice decisions. Participants provided comments that explained the reasoning behind their individual responses. In the final year of residency training, we ascertained participating residents’ chosen career. Factor analysis grouped similar sorts and revealed four distinct viewpoints. We characterized the viewpoints as “Fellowship-Bound-Academic,” “Altruistic-Longitudinal-Generalist,” “Inpatient-Burnout-Aware,” and “Lifestyle-Focused-Consultant.” There is concordance between residents who loaded significantly onto a viewpoint and their ultimate career choice. Four dominant career choice viewpoints were found among contemporary U.S. IM residents. These viewpoints reflect the intersection of competing priorities, personal interests, professional identity, socio-economic factors, and work/life satisfaction. Better appreciation of determinants of IM residents’ career choices may help address workforce shortages and enhance professional satisfaction.

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Acknowledgements

The authors wish to acknowledge Dr. Vijay Daniels for giving permission to include existing Q-sort statements into the statement set used in this study. We also acknowledge the Internal Medicine program leadership at each training program that participated in this study. The authors also acknowledge the American Society of Nephrology and the William and Sandra Bennett Clinical Scholars Program, who supported this study.

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, Duke University Medical Center, Box 3512, Durham, NC, 27710, USA

    John K. Roberts, Micah Schub, Charles W. Hargett & Myles Wolf

  2. Department of Medicine, Stanford University, Stanford, CA, USA

    Surbhi Singhal

  3. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Jamison Norwood

  4. National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA

    Thomas Cassini

  5. Department of Medicine, University of Colorado, Denver, CO, USA

    Andi Hudler & Geoffrey R. Connors

  6. Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Deepa Ramadurai

  7. Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

    Christopher C. Smith

  8. Department of Medicine, Oregon Health & Science University, Portland, OR, USA

    Sima S. Desai

  9. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jennifer Weintraub

  10. Department of Medicine, Rush University Medical Center, Chicago, IL, USA

    Scott H. Hasler

  11. University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Tyler M. Schwiesow

  12. Department of Medicine, Northwestern University, Chicago, IL, USA

    Aashish Didwania

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  1. John K. Roberts
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Contributions

All authors contributed substantially to the design, recruitment, and implementation of the study. The authors also substantially contributed to the interpretation of data as well as review and approval of the manuscript.

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Correspondence to John K. Roberts.

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10459_2022_10172_MOESM1_ESM.pdf

Supplemental Figure 1: Study Flow Diagram. Sequence of steps used to perform the Q-sort study. The figure includes a sample score sheet with forced distribution. (PDF 405 kb)

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Roberts, J.K., Schub, M., Singhal, S. et al. Exploring US internal medicine resident career preferences: a Q-methodology study. Adv in Health Sci Educ 28, 669–686 (2023). https://doi.org/10.1007/s10459-022-10172-0

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