Factors influencing medical students and junior doctors in choosing a career in surgery☆
Introduction
There is increasing evidence to suggest that surgery is no longer attracting either the quality or quantity of medical students as has traditionally been the case. This has been best highlighted in the United States where today 10% of surgical residency positions cannot be filled.1 Whilst there has been no definitive evidence of a similar decline in interest across the British Isles, there are a number of factors which indicate that a significant shortfall in recruitment to surgery may be on the horizon.
The first of these is the exponential increase in workload on surgical services in recent years; over the period 1998–2006 in England, for example, general surgery saw an 18% increase in emergency admissions, with trauma and orthopaedics and urology experiencing a rise in ‘finished consultant episodes’ of approximately 21% and 18% respectively.2 With the old age dependency ratio across Europe expected to increase substantially from its current levels of 25.4%–53.5% in 2060,3 these demands on our surgical services will continue to rise in the coming decades.
In the context of this increasing demand, the impact of the European Working Time Directive (EWTD) has yet to be fully realised. This is of particular concern in both Britain and Ireland, where the number of practicing doctors per head of population is significantly below the OECD average of 3.0 per 1000 population (2.8, 2.4 per 1000, respectively).4 Furthermore, the implementation of the Calman Reforms in the UK5 and the Buttimer Report in Ireland,6 whilst attempting to reform post-graduate training, have placed additional strain on the day-to-day provision of surgical services17, 19.
It has been predicted that the advent of graduate medical schools may have a negative impact on recruitment to surgery, based on the assumption that older medical graduates may be less inclined to choose a career in surgery given the protracted duration of post-graduate training which that will entail.7 Whilst studies have yet to demonstrate this effect, there is no question that the age profile of medical students has increased dramatically over the decade. In 1996, for example, students of 20 years and under made up 83% of those students applying to UK medical schools; this group made up 66% of applicants in 2003.8
The factors influencing career choice among juniors in Britain and Ireland have previously been addressed in some small studies;7, 9, 10, 18 this study aims to build on previous work and, to provide a more in-depth characterisation of the factors motivating medical students and newly-qualified junior doctors to choose various careers within medicine. By including respondents at different stages of training, it was hoped to identify those influences which may lessen or indeed gain in importance as progression is made through medical school and into working life, and to therefore identify those potential disincentives to surgery which may be targeted by surgical educators, thereby improving recruitment into the discipline.
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Methods
An anonymysed, structured questionnaire was distributed to 290 medical students and junior doctors affiliated to University College Hospital, Galway, having first confirmed approval from the hospital's Clincial Research Ethics Committee. The questionnaire was developed following consultation with final-year medical students, and was circulated to first- and final-year students, newly-qualified hospital doctors, and basic surgical trainees. Respondents were given the option of filling out the
Results
The response rate was 84% (243/290), 54% (n = 132) of whom were female. Respondents ranged in age from 17 to 41, with a mean age of 23 years. First-year respondents accounted for 40% of the total study group, final-year students for 28% with the remaining 32% split evenly between hospital interns and those on the Basic Surgical Training (BST) Programme (Fig. 1). Given that 16% (n = 39) of respondents were on the BST programme, and had thus already committed to a career in surgery, it was decided
Discussion
One major challenge for those attempting to maintain adequate recruitment into surgery has been the apparent move towards specialties which allow a better work-life balance. In our study, the three most important factors identified were future employment, career opportunities and intellectual challenge. Given the abundance of recent commentary on the importance of lifestyle factors, it is interesting that, overall, respondents here have identified three factors concerning their work- as opposed
Conclusion
Our results have demonstrated that the three most important influences in career choice for medical students and junior doctors are employment, career opportunities and intellectual challenge. These findings differ from the results of studies elsewhere, which placed particular emphasis on the importance of lifestyle factors. Our results may echo the global economic downturn, and a shift in people's focus to issues surrounding job security. Whatever the underlying reason, this shift presents an
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Cited by (0)
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Presented, in part, at the Association of Surgeons of Great Britain and Ireland (ASGBI) Annual Conference, Glasgow, May 2009.