Medical student specialty choices have significant downstream effects on the availability of physicians and, ultimately, the effectiveness of health systems. This study investigated how medical student specialty preferences change over time in relation to their demographics and lifestyle preferences.
Students from ten medical schools were surveyed at matriculation (2012) and graduation (2016). The two surveys included questions about specialty and lifestyle preferences, demographics, educational background, and indebtedness. Student data from 2012 to 2016 were paired together and grouped into those whose specialty preferences remained constant or switched.
Response rates in 2012 and 2016 were 65% (997/1530) and 50% (788/1575), respectively. Fourth-year students ranked “enjoying the type of work I am doing” as less important to a good physician lifestyle than did first-year students (from 59.6 to 39.7%). The lifestyle factors “having control of work schedule” and “having enough time off work” were ranked as more important to fourth-year students than first-year students (from 15.6 to 18.2% and 14.8 to 31.9%, respectively). The paired dataset included 19% of eligible students (237/1226). Demographic and lifestyle factors were not significantly associated with specialty preference switching. Additionally, no significant association existed between changing lifestyle preferences and switching specialty preference (p = 0.85).
During the course of medical school, lifestyle preferences became more focused on day-to-day factors and less on deeper motivational factors. Neither demographics nor lifestyle preferences appear to relate to a student’s decision to switch specialty preference during medical school. These findings represent an important step in uncovering causes of specialty preference trends.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Association of American Medical Colleges. The complexities of physician supply and demand: projections from 2014 to 2025; 2016 Update. 2016. Accessed June 27, 2016.
Institute of Medicine. Graduate medical education that meets the nation’s health needs. Washington, DC: The National Academies Press; 2014.
West CP, Dupras DM. General medicine vs subspecialty career plans among internal medicine residents. JAMA. 2012;308(21):2241–7.
Jolly P, Erikson C, Garrison G. U.S. graduate medical education and physician specialty choice. Acad Med. 2013;88(4):468–74.
Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA. 2003;290(9):1173–8.
Newton DA, Grayson MS, Thompson LF. The variable influence of lifestyle and income on medical students' career specialty choices: data from two U.S. medical schools, 1998-2004. Acad Med. 2005;80(9):809–14.
Bland CJ, Meurer LN, Maldonado G. Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. Acad Med. 1995;70(7):620–41.
Petersdorf RG. The doctors’ dilemma. N Engl J Med. 1978;299(12):628–34.
O’Malley AS, Rich EC, Maccarone A, DesRoches CM, Reid RJ. Disentangling the linkage of primary care features to patient outcomes: a review of current literature, data sources, and measurement needs. J Gen Intern Med. 2015;30(Suppl 3):S576–85.
Tak HJ, Hougham GW, Ruhnke A, Ruhnke GW. The effect of in-office waiting time on physician visit frequency among working-age adults. Soc Sci Med. 2014;118:43–51.
Sheldon GF. Access to care and the surgeon shortage: American Surgical Association forum. Ann Surg. 2010;252(4):582–90.
Compton MT, Frank E, Elon L, Carrera J. Changes in U.S. medical students' specialty interests over the course of medical school. J Gen Intern Med. 2008;23(7):1095–100.
Babbott D, Baldwin DC, Jolly P, Williams DJ. The stability of early specialty preferences among US medical school graduates in 1983. JAMA. 1988;259(13):1970–5.
Clinite KL, DeZee KJ, Durning SJ, et al. Lifestyle factors and primary care specialty selection: comparing 2012–2013 graduating and matriculating medical students’ thoughts on specialty lifestyle. Acad Med. 2014;89(11):1483–9.
Lepièce B, Reynaert C, van Meerbeeck P, Dory V. Social dominance theory and medical specialty choice. Adv Health Sci Educ Theory Pract. 2016;21(1):79–92.
Held ML, Zimet CN. A longitudinal study of medical specialty choice and certainty level. J Med Educ. 1975;50(11):1044–51.
Scott I, Gowans M, Wright B, Brenneis F. Stability of medical student career interest: a prospective study. Acad Med. 2012;87(9):1260–7.
Kassebaum DG, Szenas PL. Medical students’ career indecision and specialty rejection: roads not taken. Acad Med. 1995;70(10):937–43.
Zeldow PB, Preston RC, Daugherty SR. The decision to enter a medical specialty: timing and stability. Med Educ. 1992;26(4):327–32.
Geertsma RH, Grinols DR. Specialty choice in medicine. J Med Educ. 1972;47(7):509–17.
Carline JD, Greer T. Comparing physicians’ specialty interests upon entering medical school with their eventual practice specialties. Acad Med. 1991;66(1):44–6.
Association of American Medical Colleges. Table A1. Continuity of specialty preference on the Matriculating Student Questionnaire (MSQ) and the 2016 Graduation Questionnaire (GQ). Annual Report on Residents 2016. Accessed June 6, 2017.
Clinite KL, Reddy ST, Kazantsev SM, Kogan JR, Durning SJ, Blevins T, et al. Primary care, the ROAD less traveled: what first-year medical students want in a specialty. Acad Med. 2013;88(10):1522–8.
Survey Monkey Website. http://www.surveymonkey.com. Accessed June 19, 2014.
Dik BJ, Duffy RD. Calling and vocation at work: definitions and prospects for research and practice. Couns Psychol. 2009;37(3):424–50.
Tak HJ, Curlin FA, Yoon JD. Association of intrinsic motivating factors and markers of physician well-being: a National Physician Survey. J Gen Intern Med. 2017;32(7):739–46.
Jager AJ, Tutty MA, Kao AC. Association between physician burnout and identification with medicine as a calling. Mayo Clin Proc. 2017;92(3):415–22.
Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–13.
Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132–49.
Newton DA, Grayson MS. Trends in career choice by US medical school graduates. JAMA. 2003;290(9):1179–82.
DeZee KJ, Maurer D, Colt R, et al. Effect of financial remuneration on specialty choice of fourth-year US medical students. Acad Med. 2011;86(2):187–93.
The authors wish to thank Sydeaka Watson, PhD, and Mihai Giurcanu, PhD, for their assistance with statistical analyses.
The study was funded by the University of Chicago Pritzker School of Medicine Summer Research Program.
Conflict of Interest
The authors declare that they have no conflict of interest.
This study was approved or deemed exempt by the institutional review boards of all participating institutions.
Medical Education Day, University of Chicago, Dec. 1, 2016 (poster presentation); Learn Serve Lead, the Annual Meeting of the American Academy of Medical Colleges, Nov. 7, 2017 (oral presentation), Senior Scientific Session, University of Chicago Pritzker School of Medicine, May 15, 2019 (poster presentation).
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Fischer, J.P., Clinite, K., Sullivan, E. et al. Specialty and Lifestyle Preference Changes during Medical School. Med.Sci.Educ. 29, 995–1001 (2019). https://doi.org/10.1007/s40670-019-00790-6
- Career choice
- Undergraduate medical education
- Attitudes and psychosocial factors
- Curriculum development