Abstract
BackgroundCurrently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions.MethodsIn this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4) subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory.Results110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate). 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations they are treating.ConclusionThis study suggests that internal medicine trainees, and particularly males, are increasingly choosing procedure-based specialties while non-procedure based specialties, and in particular general internal medicine, are losing appeal. We need to implement strategies to ensure positive rotation experiences, exposure to role models, improved lifestyle and job satisfaction as well as payment schedules that are equitable between disciplines in order to attract residents to less popular career choices.
Highlights
There are more residents enrolled in cardiology training programs than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined [1]
In their third year of post-graduate training, Canadian internal medicine residents must decide if they are going to sub-specialize or continue training in general internal medicine. Those residents choosing to sub-specialize receive a license in both general internal medicine and the subspecialty they pursue. This two-part study involved both a survey and focus groups on three different cohorts of Canadian residents participating in the post-graduate year 4 (PGY4) internal medicine subspecialty match
(page number not for citation purposes) http://www.biomedcentral.com/1472-6920/8/37 percentage of females in medicine continues to increase and from our study it appears that females are more likely to occupy positions in specialties such as geriatrics, general internal medicine, rheumatology and endocrinology, this does not translate into an increase in the number of these specialists occupying the Canadian work force
Summary
There are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. The concern about predicted physician shortages in various subspecialties has led medical educators to question the factors that motivate internal medicine residents when making career decisions. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. The few studies that are available to inform this area target American trainees, and largely ignore Canadian residents Financial considerations such as escalating debt and lower future income potential have been identified as a reason why American graduates do not apply to primary practice or consider academic careers [4,5,6,7,8]. In order to ensure a spectrum of physicians that can meet the health care needs of Canadians, we need to ensure continued interest in general internal medicine, as well as some of the other less well-represented sub-specialty practices
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