Career choices and career progression in emergency medicine in the UK: national surveys

Abstract

BackgroundThe number of consultants in emergency medicine (EM) in the UK needs to be increased substantially. However, the UK College of Emergency Medicine reports that there are shortages of specialist trainees in EM. We analysed data about career choices for EM made by doctors in our multipurpose cohort studies of UK-trained junior doctors' career intentions. We previously reported that doctors who make early career choices for EM are less likely than doctors who choose other specialties to pursue their original specialty choice. Here, we update our findings. MethodsQuestionnaire surveys were undertaken of all doctors who graduated from all medical schools in the UK in the year-of-qualification cohorts of 1993, 1996, 1999, and 2000. Doctors were invited to complete either a postal or a web-based questionnaire in the first postgraduate year and at years 3, 5, 7, and 10 after graduation. For each survey, non-responders were sent up to five reminders. Subsequent surveys excluded only doctors who previously had indicated that they did not wish to participate, were deceased, or were untraceable after exhaustive searching. Response rates to the first-year surveys ranged from 55·5% to 78·9%. 7391 (66·7%) of 11 078 people who replied in year 1 and 7452 (71·5%) of 10 423 people who replied in year 5 also replied in year 10. We compared career choices in the earlier years with career destinations in year 10. Data were analysed by univariate cross-tabulation and χ2 tests; and we show percentages with 95% CIs. FindingsOf the doctors who told us in year 1 that EM was their first choice of long-term career, only 24·6% (95% CI 19·6–30·4) were working in EM 10 years after graduation. As comparisons, 75·8% (95% CI 73·9–77·6) of those who chose general practice, 58·4% (55·9–61·0) of those who chose surgical specialties, 50·8% (46·9–54·7) of those who chose anaesthetics, and 45·0% (42·8–47·3) of those who chose hospital physician specialties in the first postgraduate year were working in their first-year choice of specialty 10 years after graduation. Of those who specified EM as their first choice of career in year 5, 66·7% (95% CI 60·7–72·1) were working in EM 10 years after graduation. The corresponding figures for general practice, surgical specialties, anaesthetics, and the hospital physician specialties were 91·5% (95% CI 90·4–92·6), 86·9% (84·7–88·9), 86·1% (83·2–88·6), and 81·5% (79·2–83·6), respectively. Of the doctors who were working in EM 10 years after graduation, 26·3% (95% CI 21·0–32·4) had specified EM as their career choice in the first postgraduate year. By contrast, 92·4% (90·0–94·2) of practising surgeons and 74·9% (71·7–77·7) of hospital physicians in year 10 had told us in year 1 that that they wanted to be surgeons or hospital physicians, respectively. The most common initial career choices of doctors in EM 10 years after graduating, other than EM itself, were surgical specialties, general practice, hospital physician specialties, and anaesthetics. InterpretationCompared with many other specialties, doctors who pursue EM tend to choose it quite late. Therefore, EM workforce expansion could be partly achieved by opening up late routes into EM, so that trainees in other related specialties could transfer their training to EM with credit for the relevant competencies they already had, rather than having to start their core EM training from year 1. Training in EM might be most usefully linked to training in surgical specialties, hospital physician specialties, and anaesthetics. FundingThis is an independent study commissioned and funded by the Policy Research Programme (project 016/0116) in the Department of Health. The views expressed are not necessarily those of the funding body.