Specialty and Lifestyle Preference Changes during Medical School

Medical Science Educator volume 29, pages995–1001(2019)Cite this article

Abstract

Purpose

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.

Method

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.

Results

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).

Conclusions

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.

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References

  1. 1.

    Association of American Medical Colleges. The complexities of physician supply and demand: projections from 2014 to 2025; 2016 Update. 2016. Accessed June 27, 2016.

  2. 2.

    Institute of Medicine. Graduate medical education that meets the nation’s health needs. Washington, DC: The National Academies Press; 2014.

  3. 3.

    West CP, Dupras DM. General medicine vs subspecialty career plans among internal medicine residents. JAMA. 2012;308(21):2241–7.

    Article  Google Scholar 

  4. 4.

    Jolly P, Erikson C, Garrison G. U.S. graduate medical education and physician specialty choice. Acad Med. 2013;88(4):468–74.

    Article  Google Scholar 

  5. 5.

    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.

    Article  Google Scholar 

  6. 6.

    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.

    Article  Google Scholar 

  7. 7.

    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.

    Article  Google Scholar 

  8. 8.

    Petersdorf RG. The doctors’ dilemma. N Engl J Med. 1978;299(12):628–34.

    Article  Google Scholar 

  9. 9.

    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.

    Article  Google Scholar 

  10. 10.

    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.

    Article  Google Scholar 

  11. 11.

    Sheldon GF. Access to care and the surgeon shortage: American Surgical Association forum. Ann Surg. 2010;252(4):582–90.

    Google Scholar 

  12. 12.

    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.

    Article  Google Scholar 

  13. 13.

    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.

    Article  Google Scholar 

  14. 14.

    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.

    Article  Google Scholar 

  15. 15.

    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.

    Article  Google Scholar 

  16. 16.

    Held ML, Zimet CN. A longitudinal study of medical specialty choice and certainty level. J Med Educ. 1975;50(11):1044–51.

    Google Scholar 

  17. 17.

    Scott I, Gowans M, Wright B, Brenneis F. Stability of medical student career interest: a prospective study. Acad Med. 2012;87(9):1260–7.

    Article  Google Scholar 

  18. 18.

    Kassebaum DG, Szenas PL. Medical students’ career indecision and specialty rejection: roads not taken. Acad Med. 1995;70(10):937–43.

    Article  Google Scholar 

  19. 19.

    Zeldow PB, Preston RC, Daugherty SR. The decision to enter a medical specialty: timing and stability. Med Educ. 1992;26(4):327–32.

    Article  Google Scholar 

  20. 20.

    Geertsma RH, Grinols DR. Specialty choice in medicine. J Med Educ. 1972;47(7):509–17.

    Google Scholar 

  21. 21.

    Carline JD, Greer T. Comparing physicians’ specialty interests upon entering medical school with their eventual practice specialties. Acad Med. 1991;66(1):44–6.

    Article  Google Scholar 

  22. 22.

    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.

  23. 23.

    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.

    Article  Google Scholar 

  24. 24.

    Survey Monkey Website. http://www.surveymonkey.com. Accessed June 19, 2014.

  25. 25.

    Dik BJ, Duffy RD. Calling and vocation at work: definitions and prospects for research and practice. Couns Psychol. 2009;37(3):424–50.

    Article  Google Scholar 

  26. 26.

    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.

    Article  Google Scholar 

  27. 27.

    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.

    Article  Google Scholar 

  28. 28.

    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.

    Article  Google Scholar 

  29. 29.

    Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132–49.

    Article  Google Scholar 

  30. 30.

    Newton DA, Grayson MS. Trends in career choice by US medical school graduates. JAMA. 2003;290(9):1179–82.

    Article  Google Scholar 

  31. 31.

    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.

    Article  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Sydeaka Watson, PhD, and Mihai Giurcanu, PhD, for their assistance with statistical analyses.

Funding/Support

The study was funded by the University of Chicago Pritzker School of Medicine Summer Research Program.

Author information

Affiliations

  1. University of Chicago Pritzker School of Medicine, 924 E 57th St., Suite 104, Chicago, IL, 60637, USA

    Jonathan P. Fischer & Eric Sullivan

  2. Santa Rosa Family Medicine Residency, University of California, San Francisco, San Francisco, CA, USA

    Kimberly Clinite

  3. Department of Sociology, University of North Carolina- Chapel Hill, Chapel Hill, NC, USA

    Tania M. Jenkins

  4. Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Christina L. Bourne

  5. Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA

    Calvin Chou

  6. Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA

    Gretchen Diemer

  7. Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Dana Dunne

  8. Department of Family & Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA

    Paul J. Hartung

  9. Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA

    Doug Paauw

  10. Department of Medicine, Cook County Hospital and Health System, Chicago, IL, USA

    Shalini Reddy

Authors
  1. Jonathan P. Fischer
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  2. Kimberly Clinite
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  3. Eric Sullivan
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  4. Tania M. Jenkins
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  5. Christina L. Bourne
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  6. Calvin Chou
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  7. Gretchen Diemer
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  8. Dana Dunne
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  9. Paul J. Hartung
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  10. Doug Paauw
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  11. Shalini Reddy
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Corresponding author

Correspondence to Jonathan P. Fischer.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved or deemed exempt by the institutional review boards of all participating institutions.

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Additional information

Previous Presentations

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).

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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

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Keywords

  • Career choice
  • Undergraduate medical education
  • Attitudes and psychosocial factors
  • Curriculum development