Article

Factors influencing career choice in ophthalmology

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Abstract

To investigate the factors influencing choice of ophthalmology as a career in medicine. Data were extracted from the 2004 National Physician Survey, a questionnaire distributed to all physicians across Canada. Data were categorized by medical discipline, and chi2 comparative analyses were done. Intellectual stimulation emerged as the most frequently cited factor influencing career choice for ophthalmologists and nonophthalmologists alike (81% and 79%, respectively). Compared with other physicians, ophthalmologists were significantly more likely to cite flexibility (58% vs. 42%, respectively), mentorship (42% vs. 31%, respectively), and earning potential (38% vs. 26%, respectively) as important factors (p<0.001). Intellectual stimulation is the principal reason physicians pursue a career in ophthalmology. Ophthalmologists cite flexibility, mentorship, and earning potential as important factors more frequently than do physicians of other disciplines.

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... As echoed in a previous study of practicing ophthalmologists, interest in the field stemming from the appeal of the dual medical and surgical nature of the discipline emerged as the major factor influencing the choice of ophthalmology as a career. 1 Mentorship and flexibility also emerged as important factors. These findings support the notion that recent increased interest in ophthalmology training programs likely originates primarily from the appeal of the field itself, with flexibility and lifestyle issues playing significant but secondary roles. ...
... These findings support the notion that recent increased interest in ophthalmology training programs likely originates primarily from the appeal of the field itself, with flexibility and lifestyle issues playing significant but secondary roles. 1,2 Most residents surveyed (71%) explained that they had had very little exposure to ophthalmology in their undergraduate medical studies. Since undergraduate experiences are limited, it is probable that only those who have had good mentorship experiences consider ophthalmology as a career. ...
... 3,4 These findings in the present study highlight the importance of strengthening current undergraduate ophthalmology curricula to ensure that high-achieving students with innate talents for the discipline continue to be attracted to ophthalmology residency programs. 1,3,4 The future practice pattern of ophthalmology in Canada will be determined by a myriad of factors. Important con- siderations, such as an aging patient demographic, an aging workforce, the expansion of new technologies, and increased patient expectations will exert pressure on the provision of eye care in Canada. ...
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There has been little investigation into the attitudes and aspirations of current ophthalmology residents. The object of this study was to investigate the factors influencing career choice and to identify the future plans of Canadian ophthalmology residents. All ophthalmology residents in English Canadian ophthalmology residency training programs were invited to complete an anonymous survey in June 2006. Data were categorized by demographic variables and basic statistics; chi2 comparative analyses were performed. Of 128 residents surveyed, 49 (38%) responded to the survey. Having the ability to combine medicine and surgery was the most common factor influencing the decision to pursue ophthalmology (98% of respondents), with intellectual stimulation (76%) and mentorship (50%) also emerging as important factors. The majority of residents (62%) plan on pursuing fellowship training, with medical retina, anterior segment/cataract, and cornea being the most popular choices (36%, 34%, and 32%, respectively). Most residents expressed plans of pursuing fellowships abroad, and only 22% planned on training within Canada. Fourteen percent indicated an interest in performing laser refractive surgery, female residents being significantly less likely than males to express such an interest (0% vs. 21%; p < 0.02). Most residents (71%) expressed the wish to practice in an urban or suburban setting, with only 6% intending to work in a rural community. The appeal of the dual medical and surgical nature of ophthalmology is the most common motivating factor for pursuing an ophthalmology residency. The trends identified, including the high level of interest in subspecialty training and the desire to work in an urban setting, have important implications for the future of ophthalmology in Canada.
... In addition to data on career choice and certainty of choice, we present data on factors affecting career choices for ophthalmology. There are few published UK data on this topic; a US study in 2003 [5] and a Canadian study in 2004 [6] provide the most recent comparative information . In the US, lifestyle considerations were important to those who chose general ophthalmology careers, while those who chose specific subspecialties within ophthalmology were more likely to do so because of the perceived prestige and personal marketability which such skills would provide. ...
... Notwithstanding this, enthusiasm and commitment to the specialty was high among those who chose it, and was similar to that in other surgical specialties. These findings were similar to those in the US and Canadian studies [5,6]. Once young medical graduates have decided that they want to go into ophthalmology, they tend to be strongly committed to the specialty. ...
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The paper aims to report trends in career choices for ophthalmology among UK medical graduates. Postal questionnaire surveys were undertaken of qualifiers from all UK medical schools in nine qualification years since 1974. Data were analysed by univariate cross-tabulation. The significance of comparisons between groups of doctors were calculated by the use of chi-squared tests and adjusted residuals. Ophthalmology was the first choice of long term career for 2.3% of men and 1.5% of women one year after qualification; 2.0% of men and 1.4% of women three years after; and 1.8% of men and 1.2% of women at five years. Comparing early choices with eventual destinations, 64% who chose ophthalmology in year one, 84% in year three, and 92% in year five eventually practised in the specialty. The concordance between year one choice and eventual destination was higher for ophthalmology than for most other specialties. 'Enthusiasm for and commitment to the specialty' was the most important single factor in influencing career choice. The prospect of good working hours and conditions was also an important influence: it influenced career choice a great deal for a higher percentage of those who chose ophthalmology (66% in the third year) than those who made other surgical choices (23%). Those choosing ophthalmology show a high level of commitment to it. Their commitment is strengthened by the prospect of attractive hours and working conditions. Many doctors who become ophthalmologists have already made their choice by the end of their first post-qualification year.
... This may contribute to a more difficult work-life balance, which is more commonly cited by women than men as a reason not to pursue a specialty. 13 As mentorship can play a key role in career development, 14 we hypothesized that female trainees with female surgical retina mentors would be more likely to pursue VRS training. While we found no statistically significant difference between VRS and NVRS trainees having a female VRS mentor, and no significant difference in retina mentorship opportunities between males and females pursuing surgical retina, 33.3% of NVRS female trainees thought having a female mentor would have made them more likely to pursue the field. ...
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Objective The aim of this study was to understand the factors that ophthalmology trainees consider in pursuing vitreoretinal surgery (VRS) fellowship training. Methods This is a prospective observational survey study. Survey invitations were disseminated to postgraduate year 4 (PGY)-4 ophthalmology residents at Accreditation Council for Graduate Medical Education-accredited residency programs and surgical retina fellows at Association of University Professors of Ophthalmology Fellowship Compliance Committee-compliant fellowship programs in the United States. Survey questions on factors related to VRS were administered employing a 5-point Likert scale. Responses from ophthalmology residents pursuing surgical retina were combined with surgical retina fellows' responses and compared with responses from PGY-4 residents not pursuing vitreoretinal surgery. Results Eighty-one resident surveys were completed. Forty-three fellow surveys were completed. Fifty-seven out of eighty-one (70.4%) residents were not pursuing surgical retina, and a total of 67 trainees (24 residents, 43 fellows) were pursuing surgical retina. The following factors were associated with pursuing VRS training: male gender (p = 0.031); having performed retina research during residency (p ≤ 0.001); enjoying surgical retina procedures (p ≤ 0.001), enjoying surgical retina patient outcomes (p ≤ 0.001), and working with vitreoretinal surgeons (p ≤ 0.001); finding surgical retina prestigious (p ≤ 0.001); perceiving their residency having a strong record of matching surgical retina (p = 0.039); liking the potential financial income from surgical retina (p ≤ 0.001); and having vitreoretinal mentors during residency (p = 0.014). A majority of trainees (31/57, 54.4%) not pursuing surgical retina disagreed or strongly disagreed with enjoying the patient outcomes in surgical retina. A third of female residents not pursuing surgical retina felt having a female surgical retina mentor would have made them more likely to pursue the field. Conclusion Longer retina rotations, encouraging resident participation in retina research, and increasing mentorship opportunities of female trainees from female retina specialists may increase resident interest in pursuing surgical retina fellowship.
... Ophthalmology offers doctors a controllable lifestyle, high intellectual content, a good reputation as a specialty, and, in some countries, high earning potential. [1][2][3][4][5] The importance of flexible work hours has been highlighted by female doctors 6,7 while financial considerations 2 and prestige 8 have been important to the career choices of male doctors. ...
Article
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Objective Using data from 40 years of national surveys of UK medical graduates, we report on ophthalmology as a career choice. Design, setting, and participants Self-administered questionnaire surveys of all graduates from all UK medical schools in selected years of qualification between 1974 and 2015. Main outcome measures Career specialty preferences of doctors one, three, and five years after graduation; career specialty destinations 10 years after graduation. Results One year after graduation, ophthalmology was the first career preference of 1.6% of the qualifiers of 1974–83, 2.2% of 1993–2002, and 1.8% of 2005–15. The corresponding percentages three years after graduation were 1.5, 1.8, and 1.2%. Men were more likely than women to choose ophthalmology: among graduates of 2005–15, 2.4% of men and 1.4% of women did so at one year, as did 1.7% of men and 0.7% of women at five years. Seventy per cent of doctors practising as ophthalmologists 10 years after qualification had told us in their first post-qualification year that ophthalmology was their first choice of career. Conclusions There has been no systematic change in recent years in the proportion of recent medical graduates intending to have a career in ophthalmology when surveyed one year after graduation. However, the proportion at three and five years after graduation was lower than that at year 1. Suggestions for maintaining interest in the specialty include improved career advice, greater early clinical exposure to ophthalmology, and improved access to flexible training. Most practising ophthalmologists had made early decisions that this was their intended career.
... According to previous studies (9,(24)(25)(26)(27), the main reasons for choosing ophthalmology as a career are the possibility of performing surgical procedures, flexibility, earning potential and intellectual stimulation. ...
Article
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Objectives: The increasing demand for medical specialties with flexible working hours has been associated with the important role of quality of life as a determining factor when choosing a career in medicine, which might change the motivations for pursuing a career in ophthalmology. We aim to identify the main determinants of ophthalmology as a career choice as well as the reasons that motivated previous generations to follow this path. Methods: Responses to self-administered online questionnaires were analyzed. Results: A total of 225 responses were analyzed, including those of baby boomers (21), generation X (48), generation Y (131) and generation Z (25). Although the main reasons for choosing ophthalmology as a career are the same for all the generations in this study (flexible working hours, self-satisfaction from helping people improve their vision and the possibility of performing surgical procedures), some reasons for this career choice are more important to the younger generations (short-term results and short procedures), and some are more important to the older generations (the influence of an ophthalmologist in the family). Conclusion: The main reasons for choosing ophthalmology as a career are essentially the same over time. The differences in secondary motivations could be explained by generational differences.
... Mentorship has a major influence on motivation among residents and on their reasons for pursuing a career in ophthalmology. 7,8 The benefits of effective mentorship are well documented and include stress reduction, insight into balancing work and personal life, easing career choices, and promoting political advocacy. [9][10][11] The gaps left by the formal curriculum can be adequately addressed by a devoted mentor, who can help prepare young ophthalmologists for nonclinical areas of practice, especially business operations and personal finance management. ...
... This issue is, as mentioned, extremely important, but has been well covered elsewhere. [42][43][44][45][46][47][48][49][50][51][52] Several reports have evaluated why students choose to become doctors. 10-12 One study, by Millan and colleagues, 11 found that most students had strong valuation of humanistic aspects of medicine. ...
Article
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To get an idea of whether the issue of what makes people healthier is studied in ophthalmology by determining the proportion of articles dealing with that subject. Prospective review of all articles published in 3 consecutive issues of 7 peer-reviewed ophthalmology journals, using a grading system in which A signified an article that clearly dealt with a subject expected to have an impact on health or quality of life, or that considered health or quality of life itself directly; B indicated an article similar to A, but not directly concerned with the issue of health; C signified an article similar to B but more distantly related to health or quality of life; and D was the grade given when there was no relationship at all to health or quality of life. Grading was done independently by 3 graders. A literature review on the subject was also performed. Thirty-three articles received a grade of A, 229 of B, 740 of C, and 81 of D. There were more articles that had no relationship at all to health or quality of life than there were articles dealing directly with those issues. On the basis of a review of the literature and of over 1000 articles, ophthalmologists do not appear to give much priority to issues of quality of life or health. How validly these conclusions can be generalized to general clinicians is not known.
Article
Purpose: To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction. Methods: A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area. Results: Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life. Conclusions: The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs.
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Objective To characterise the contributing factors that affect medical students’ subspecialty choice and to estimate the extent of influence of individual factors on the students’ decision-making process. Design Systematic review and meta-analysis. Methods A systematic search of the Cochrane Library, ERIC, Web of Science, CNKI and PubMed databases was conducted for studies published between January 1977 and June 2018. Information concerning study characteristics, influential factors and the extent of their influence (EOI) was extracted independently by two trained investigators. EOI is the percentage level that describes how much each of the factors influenced students’ choice of subspecialty. The recruited medical students include students in medical school, internship, residency training and fellowship, who are about to or have just made a specialty choice. The estimates were pooled using a random-effects meta-analysis model due to the between-study heterogeneity. Results Data were extracted from 75 studies (882 209 individuals). Overall, the factors influencing medical students’ choice of subspecialty training mainly included academic interests (75.29%), competencies (55.15%), controllable lifestyles or flexible work schedules (53.00%), patient service orientation (50.04%), medical teachers or mentors (46.93%), career opportunities (44.00%), workload or working hours (37.99%), income (34.70%), length of training (32.30%), prestige (31.17%), advice from others (28.24%) and student debt (15.33%), with significant between-study heterogeneity (p<0.0001). Subgroup analyses revealed that the EOI of academic interests was higher in developed countries than that in developing countries (79.66% [95% CI 70.73% to 86.39%] vs 60.41% [95% CI 43.44% to 75.19%]; Q=3.51, p = 0.02). The EOI value of prestige was lower in developed countries than that in developing countries (23.96% [95% CI 19.20% to 29.47%] vs 47.65% [95% CI 34.41% to 61.24%]; Q=4.71, p=0.01). Conclusions This systematic review and meta-analysis provided a quantitative evaluation of the top 12 influencing factors associated with medical students’ choice of subspecialty. Our findings provide the basis for the development of specific, effective strategies to optimise the distribution of physicians among different departments by modifying these influencing factors.
Article
Background: There is a dearth of studies on career intensions of interns in India in general and Ophthalmology in particular. The exposure in ophthalmology as an undergraduate trainee as well as an intern is lesser in comparison with other major subjects like medicine and surgery. As a result their understanding of the specialty as a career option could be inadequate and biased. The results of this study could be used to assess the need of incorporating career guidance in ophthalmology during internship. Aim: To study the medical interns' perspective of Ophthalmology as a career and to analyze the factors that might influence their decision. Methods and Material: All interns undergoing compulsory rotatory internship in a medical college in Dakshina Kannada were included in the prospective, questionnaire based study, conducted from September to December 2010. Summary statistics are generated using MS Excel, and most are presented as frequencies and percentages. Chi square /and Fisher's exact test of significance was used wherever applicable and the significance is reported at 5% level. Observation: Most respondents (33.9%) had ophthalmology as their third choice for pursuing post graduation. There was no significant gender preference (p=0.623) for the branch. 41.5% (37) said that they would not take up ophthalmology because they felt they lacked skill / fine motor co-ordination in activities. 57.3% (51) would opt for this specialty because there was scope for more family time.56.1% (50) would not want to take it up because there was a lot of dependence on equipment for diagnosis. Conclusions: Ophthalmology is amongst the top five preferred branches for specialization. It is most preferred for its perceived controllable lifestyle. Perceived lack of inherent skill was an important deterring factor. Incorporation of career counseling and hand-eye coordination tests during internship will help dispel myths about the speciality and aid decision making.
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The choice of an appropriate career, occupation or profession is one of the most important decisions that one makes in life and there are many factors which may influence such a decision. The purpose of this study was to establish the factors which influenced students currently studying optometry in South African institutions in deciding on the course of study and choice of institution. Data was collected with a questionnaire on demographics of the students and the factors that might have influenced their choice of optometry as a career and their institution of learning. Data was analysed with descriptive and cross-tabulation statistics. Three hundred and eighty seven students responded to the questionnaire (80.1% response rate). Their ages ranged from 17 to 40 years with a mean of 20.73 ± 2.46 years and included 30.5% males and 69.5% females. They were from the University of Free State (25.1%), University of Johannesburg (29.5%), University of KwaZulu-Natal (29.7%) and the University of Limpopo (15.7%). There were 38% Whites, 36.7% Blacks, 22.2% Indians and 3.1% Coloureds. The highest rated factors which influenced their choice of optometry were the desire to help other people (92.8%), job availability after graduation (92%), subjects passed and points obtained in the matric year (91.2%) and the potential to earn a good salary (88.6%), respectively. Few rated news and other media (20.9%) as an important factor in their decision to choose their current institution of learning while 29.5% reported that failure to gain admission to study other degrees was an important factor. These results may be useful to institutions offering optometry degrees to formulate effective recruitment strategies to attract quality students. Also, they may be useful to career counsellors in counselling prospective students on their career choice and institution of learning. (S Afr Optom 2011 70(1) 21-28)
Article
Hintergrund Ziel der vorgestellten Umfrage war es, die aktuellen Arbeitsbedingungen des ophthalmologischen Nachwuchses darzustellen, um mögliche Defizite aufzuzeigen und so die wissenschaftliche Ausbildung gezielt fördern zu können. Studiendesign und Untersuchungsmethoden In der Zeit von Oktober 2008 bis März 2009 wurden im Rahmen einer Online-Befragung 187 Augenärzte aus Universitätskliniken und Lehrkrankenhäusern zu 4 Themenkomplexen befragt. Ergebnisse Das mittlere Alter der Teilnehmer betrug 32±4 Jahre. 48% der teilnehmenden Ärzte überschreiten 4- bis 5-mal pro Woche die reguläre Arbeitszeit. Eine Freistellung für Forschungsarbeiten haben 76% der Befragten noch nie erhalten. Dabei haben schon 33% selbstständig Drittmittel eingeworben. Jedoch weisen 26% keine Publikationsleistung auf und 25% haben noch nie einen Vortrag gehalten. Über einen ausreichenden oder vollständigen Zugang zu wissenschaftlichen Zeitschriften verfügen 59%. 45% aller Befragten hätten Bedarf an einem englischsprachigen Übersetzer, haben aber keinen Zugriff darauf. Kongresse werden im Mittel an 6,3 Tagen besucht. Alle Befragten würden sich wieder für das Fach Augenheilkunde entscheiden. 28% würden sich hingegen nicht wieder an der eigenen Klinik bewerben. Schlussfolgerung Die Arbeitsbedingungen an Universitätskliniken und Lehrkrankenhäusern für Augenheilkunde sind derzeit nicht geeignet, die ophthalmologische Wissenschaft in Deutschland zu stärken. Neben der Etablierung strukturierter Weiterbildungspläne, welche die Forschungstätigkeit berücksichtigen, muss die Betreuung des wissenschaftlichen Nachwuchses deutlich verbessert werden.
Article
Purpose By evaluating the current working conditions of young ophthalmology researchers in Germany, potential deficits should be highlighted to create a greater transparency. Patients and methods Within the time period between October 2008 and March 2009 all residents and junior researchers at university eye hospitals and teaching hospitals were invited to participate in an open online survey to retrieve validated data on four different topics. Results A total of 187 validated residents filled out the questionnaire consisting of 48 items. The mean age of the 84 women and 77 men was 32±4 years and 48% of the physicians reported exceeding the normal working hours (by law) 4-5 times per week. Of the respondents 76% ruled out ever being supported in their research activities by a temporary release from clinical work. Nevertheless, several indices indicated enthusiastic career aspirations and research activities. The career success scale was greater than 5 in 70 (37%) of the participants (mean: 4.5). An adequate access to ophthalmologic online journals was indicated only by 59% of the people surveyed and 45% of scientists required additional support by English native speakers when writing a scientific manuscript. All physicians interviewed would decide in favor of ophthalmology again when asked which discipline would be chosen and 28% of the residents would not apply for a job at the same institution again. The atmosphere,access to surgical training and the quality of teaching were specified as the most important factors in the career decision in favor of a certain university. Conclusion Some deficits of the training and working conditions could be clearly identified in the view of ophthalmology residents. Facing the unbroken high attractiveness of clinical disciplines, the provided insights can support further training programs and research incentives to improve the scientific output and ophthalmologic research in the long term.
Article
By evaluating the current working conditions of young ophthalmology researchers in Germany, potential deficits should be highlighted to create a greater transparency. Within the time period between October 2008 and March 2009 all residents and junior researchers at university eye hospitals and teaching hospitals were invited to participate in an open online survey to retrieve validated data on four different topics. A total of 187 validated residents filled out the questionnaire consisting of 48 items. The mean age of the 84 women and 77 men was 32±4 years and 48% of the physicians reported exceeding the normal working hours (by law) 4-5 times per week. Of the respondents 76% ruled out ever being supported in their research activities by a temporary release from clinical work. Nevertheless, several indices indicated enthusiastic career aspirations and research activities. The career success scale was greater than 5 in 70 (37%) of the participants (mean: 4.5). An adequate access to ophthalmologic online journals was indicated only by 59% of the people surveyed and 45% of scientists required additional support by English native speakers when writing a scientific manuscript. All physicians interviewed would decide in favor of ophthalmology again when asked which discipline would be chosen and 28% of the residents would not apply for a job at the same institution again. The atmosphere, access to surgical training and the quality of teaching were specified as the most important factors in the career decision in favor of a certain university. Some deficits of the training and working conditions could be clearly identified in the view of ophthalmology residents. Facing the unbroken high attractiveness of clinical disciplines, the provided insights can support further training programs and research incentives to improve the scientific output and ophthalmologic research in the long term.
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Despite equalization of the ratio of men and women among matriculating medical students, it is possible that different rates of success for applicants at the level of resident selection in the annual residency match may occur on the basis of sex. As part of a larger project, we examined this issue across the medical specialties. In the current article, the effect of sex on resident selection within the specialty of ophthalmology is explored. Data were obtained from the Canadian Medical Association, Canadian Institute for Health Information, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, and Canadian Residency Matching Service regarding sex- and age-specific demographics, as well as success rates for male and female applicants ranking an ophthalmology residency program as their top choice. The proportion of men who ranked ophthalmology as their top choice but did not match to any ophthalmology program was compared to the corresponding proportion of women. The female: male ratio of practicing ophthalmologists has slowly increased over the past decade and is highest (0.41:1) within the under-45 age group. By grouping data from 1993 to 2004, we found that men who ranked an ophthalmology program as their first choice had odds of not being accepted to an ophthalmology program that were 1.1 times (95% confidence interval 0.8-2.0; p=0.34) the corresponding odds for women. Our data suggest that discrimination on the basis of sex does not occur at the level of residency selection. The lower level of female recruitment may be due to decreased interest in this specialty among women. Nonetheless, the proportion of female ophthalmologists within the Canadian workforce continues to increase.
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To explore the relationship between exposure to clinical role models during medical school and the students' choice of clinical field for residency training, and to estimate the strength of this association. Cross-section study. McGill University School of Medicine, Montreal, Canada. Of the 146 graduating medical students in the class of 1995, 136 participated. Clinical field chosen by students for residency training and the students' assessment of their exposure to and interaction with physician role models were the main measurements. Ninety percent of graduating students had identified a role model or models during medical school. Personality, clinical skills and competence, and teaching ability were most important in the selection of a role model, while research achievements and academic position were least important. Odds ratios between interacting with "sufficient" role models in a given clinical field and choosing that same clinical field for residency were 12.8 for pediatrics, 5.1 for family medicine, 4.7 for internal medicine, and 3.6 for surgery. Most students (63%) received career counseling and advice from their role models. Exposure to role models in a particular clinical field is strongly associated with medical students' choice of clinical field for residency training. Knowing which characteristics students look for in their role models should help identify the physicians who may be most influential in medical students' career choice.
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Recent emphasis in medical education has been to encourage students to pursue primary care careers. This could have a negative impact on applications to surgical residencies. To determine what factors are most influential for a student to pursue a surgical career in spite of this environment, third- and fourth-year medical students were surveyed with a 40-item questionnaire. The response rate was 37% (76/205). Those students considering a career in surgery were more likely than their counterparts to be motivated by role models (P <.006), career opportunities (P <.006), and academic opportunities (P <.013) in surgery. They were less likely than their counterparts to be discouraged from surgery on the basis of lifestyle (P <.001), time commitment (P <.001), call schedules (P <.001), or residency length (P <.028). No differences regarding financial rewards, research opportunities, or intellectual challenges were seen between the groups. Neither race nor sex had a significant role in the selection of surgery as a career. The data suggests that students are more likely to be influenced to pursue surgical careers by offering early exposure to positive role models and career and academic opportunities in surgery. Knowledge of these influences on student career choices should help surgical educators attract and maintain student interest in surgical careers.
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It is difficult to determine relative competitiveness of surgical training positions: there is no single source for matching process results and specialty-specific competitiveness may change over time. This study was undertaken to address these issues. Numbers of matched/unmatched students and positions offered/filled for surgical specialties were analyzed for specialty-specific trends in match rates and differences among specialty match rates over time. From 1996 to 2000, match rates increased for neurological surgery, general surgery and otolaryngology; decreased for ophthalmology and urology and were unchanged for orthopedic surgery. Although the "most competitive" and "least competitive" specialties changed each year, unmatched student numbers uniformly exceeded unfilled position numbers. Match rates changed over time; no single specialty was consistently most or least competitive. Unmatched students were unlikely to successfully "scramble" for an advanced/categorical training position in any surgical specialty because of the uniformly very high fill rates.
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An ongoing debate exists among health care researchers about the mechanism that allocates physicians across medical specialties, and appropriate policy measures to correct imbalances that may arise from time to time. Most researchers believe that choice of residency program by medical school graduates is key to understanding how physicians are distributed across specialties, but there is much disagreement about whether economic or non-economic factors are most influential in determining this choice. We undertake an empirical investigation of two potentially important economic factors: income and leisure. To do so, we specify a two way error component regression model to estimate the effects of expected earnings and available leisure time, and uncertainty of earnings and leisure, on specialty choices of medical residents. Our findings indicate that economic factors are an important influence in the specialty choice process; in particular, medical residents are attracted to specialties that offer the prospect of longer and more certain annual vacations, higher earnings, shorter residency programs, and more certain work schedules. Our results suggest that employment contracts that provide generous annual vacation time and promise regular weekly work schedules may be more effective than increased earnings in correcting the current perceived shortage of primary care physicians.
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There has been a perception that fewer medical students are currently pursuing careers in general surgery. To investigate the validity of this premise we reviewed the Canadian Residency Matching Service (CaRMS) database from 1996 to 2001 and identified recent trends in graduates' selections. Three surgical specialties--general surgery, orthopedic surgery, obstetrics and gynecology--were chosen for analysis as "poor lifestyle" specialties. They were compared to anesthesia, diagnostic radiology, and ophthalmology, which were chosen as representative "good lifestyle" specialties. Linear regression and chi-square analyses were performed to identify significant changes in applications to each specialty. A negative trend in first-choice applications to all three "poor lifestyle" specialties was observed, whereas all three "good lifestyle" specialties experienced increased first-choice applicants. Potential factors influencing medical student residency selection are discussed, emphasizing the reduced number of first-choice applicants to general surgery.
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Recent specialty choices of graduating US medical students suggest that lifestyle may be an increasingly important factor in their career decision making. To determine whether and to what degree controllable lifestyle and other specialty-related characteristics are associated with recent (1996-2002) changes in the specialty preferences of US senior medical students. Specialty preference was based on analysis of results from the National Resident Matching Program, the San Francisco Matching Program, and the American Urological Association Matching Program from 1996 to 2002. Specialty lifestyle (controllable vs uncontrollable) was classified using earlier research. Log-linear models were developed that examined specialty preference and the specialty's controllability, income, work hours, and years of graduate medical education required. Proportion of variability in specialty preference from 1996 to 2002 explained by controllable lifestyle. The specialty preferences of US senior medical students, as determined by the distribution of applicants across selected specialties, changed significantly from 1996 to 2002 (P<.001). In the log-linear model, controllable lifestyle explained 55% of the variability in specialty preference from 1996 to 2002 after controlling for income, work hours, and years of graduate medical education required (P<.001). Perception of controllable lifestyle accounts for most of the variability in recent changing patterns in the specialty choices of graduating US medical students.
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In this paper, we study physician specialty decisions using several unique data sets which include information on almost all Canadian physicians who practised in Canada between 1989 and 1998. Unlike previous studies, we use a truly exogenous measure of potential income across general and specialty medicine to estimate the effect of income on physicians' specialty choices. Furthermore, our estimation procedure allows us to purge the income-effect estimates of non-pecuniary specialty attributes which may be correlated with higher paying specialties. Understanding the effect of potential income (and other variables) on choices is necessary if the desired mix across generalists and specialists as well as across specialties is to be achieved. Our results show that physicians respond to differences in income when making their specialty decisions.
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Recent reports on medical students' career choices suggest that lifestyle increasingly influences career decisions. The authors addressed the changing influence of lifestyle and income on career choice, how these influences differ by specialty, and the specific careers students identify as lifestyle friendly. From 1998 to 2004, 1,334 (73%) fourth-year medical students from Brody School of Medicine at East Carolina University (no. = 485 graduates) and New York Medical College (no. = 1,348 graduates) completed a questionnaire that addressed career specialty preferences, as well as income and lifestyle concerns. Students were asked to rate career choice influences on a four-point scale (1 = no influence, 4 = major influence). Factor analysis of these influences identified seven factors including one each for lifestyle and income. A total of 1,327 students indicated a career preference. Lifestyle (p = .018) and income (p = .011) were found to increasingly influence medical students' career choices during the study period. Overall, the authors found significant differences between specialties in the relative contribution of these factors. Students' perceptions of specialties existed on a continuum of lifestyle friendly (e.g., radiology) to lifestyle unfriendly (e.g., obstetrics-gynecology). Contrary to previous reports, the students' responses indicate they perceived the primary care specialties as lifestyle intermediate compared to other specialties. Lifestyle and income have become more important to medical students in their career choice, and the relative influence of these factors varies considerably between specialties. This study suggests that previous efforts to dichotomize careers into those with controllable and uncontrollable lifestyles may mask important complexities.
Article
Results from the 2004 National Physician Survey illustrate interesting differences in how physicians choose their specialty (Fig. 1). Fig. 1: Factors influencing second-year residents' choice of residency training, by sex and broad residency class (family medicine v. specialty medicine). Source: 2004 CFPC/CMA/RCPSC National Physician Survey. Among second-year residents who completed the survey, those who chose family medicine claimed that the most important factors were the doctor– patient relationship, and workload flexibility and predictability; the least important factors included prestige, earning potential and research potential. Residents enrolled in specialties reported being influenced mostly by the level of intellectual stimulation and challenge; prestige and earning potential played a greater role than they did for family medicine residents. There were also differences between male and female residents. In family medicine, female trainees were more likely than their male counterparts to choose level of intellectual stimulation and challenge, doctor– patient relationship, and workload flexibility and predictability as important influences, whereas the opposite was true for ability to pursue non-work-related interests, training opportunities and earning potential. Among residents in specialty training programs, female trainees were again more likely than the male residents to choose doctor– patient relationship as an important influence, whereas more male than female residents chose training opportunities, workload flexibility and predictability, influence of a mentor, ability to pursue non-work-related interests, earning potential, research opportunities and prestige. The results give some insight into how today's medical trainees select which career path to follow. Although factors such as earning potential and prestige played an important role for some, most residents were influenced by their interest level in a particular field and the level of intellectual challenge involved as well as by lifestyle issues such as workload predictability and flexibility. These survey results support the current view that today's trainees are more interested in factors related to lifestyle than to prestige, and they may help explain the decreased interest in fields such as cardiac surgery and neurosurgery, which were previously highly competitive. — Mark O. Baerlocher, Toronto
How do we choose our specialty? Key words: ophthalmology, residency, career choice, motivation Career choice in ophthalmology—Noble CAN J OPHTHALMOL—VOL
  • Mo Baerlocher
Baerlocher MO. How do we choose our specialty? CMAJ 2006;174:757. Key words: ophthalmology, residency, career choice, motivation Career choice in ophthalmology—Noble CAN J OPHTHALMOL—VOL. 41, NO. 5, 2006 599
Available: http://www.cfpc.ca
National Physician Survey (NPS) 2004. Available: http://www.cfpc.ca/English/cfpc/research/janus project/nps/background http://www.cfpc.ca (accessed 2005 Nov 25).