Controllable Lifestyle Specialties Research Articles

Survey on Specialty Preference and Work-Life Balance among Residents of Japanese Red Cross Hospitals.

Introduction: The paucity and maldistribution of physicians among various specialties are key issues facing the Japanese health care system. Studies have shown that young physicians place more emphasis on work-life balance while selecting their specialty and that they prefer controllable lifestyle (CL) specialties over noncontrollable lifestyle (NCL) specialties. As this may be a cause of maldistribution, we investigated the relationship between views on work-life balance and specialty selection among young physicians in Japan.Methods: An online questionnaire was sent to 1451 residents (postgraduate years 1-5) at 60 Japanese Red Cross hospitals across Japan. Results: In all, 226 physicians responded (response rate: 15%), with 21% in CL and 74% in NCL specialties. When compared with NCL specialties, CL specialties had less overtime (43% vs. 16%, p = 0.001), considered life to be more important than work (26% vs. 15%, p = 0.018), and were more likely to give precedence to work-life balance over medical interest while choosing their specialty (49% vs. 30%, p < 0.001). Furthermore, physicians were more likely to change their choice of specialty, contrary to their professional interest, because of social reasons (49% vs. 26%, p = 0.007). Conclusions: Our study suggests that young physicians in CL specialties have better working hours and place more emphasis on work-life balance while choosing their specialty compared with those in NCL specialties. The increase in the number of physicians in CL specialties is likely attributable to the growing preference for an optimal work-life balance among young physicians; this seems to have increased the maldistribution of physicians among various specialties. Institutional mechanisms to support the lifestyle of physicians (especially in NCL specialties) are required to provide a balanced medical service in Japan.

Residency Specialty Choice Trends Over 24 Years

Studies have shown a decrease in the match rate in general medical and primary care-focused specialties among US medical school graduates and an increase in that of subspecialties with “controllable lifestyles.” We evaluated the percentage of Harvard Medical School graduates who matched into high-income controllable lifestyle, low-income controllable lifestyle, and noncontrollable lifestyle specialties from 1994 to 2017. Using linear regression, we found that the percentage of students matching into high-income and low-income controllable lifestyle specialties has increased over time, while those matching into noncontrollable lifestyle specialties – comprised largely of primary care fields – decreased. Such trends may impact the US physician workforce composition over time, with growth of residency positions into fields such as internal medicine exceeding the matriculation of U.S. medical graduates into these positions. We examine whether future policies should focus on incentivizing students to pursue such noncontrollable lifestyle specialties by highlighting controllable lifestyle elements within these fields and emphasizing alternative rewards which may attract candidates to these pursuits. Keywords: RESIDENCY SPECIALTY CHOICE TRENDS, CONTROLLABLE LIFESTYLE, INCOME LEVEL, CAREER CHOICE

Medical Specialty Choice and Related Factors of Brazilian Medical Students and Recent Doctors.

BackgroundChoosing a medical specialty is an important, complex, and not fully understood process. The present study investigated the factors that are related to choosing and rejecting medical specialties in a group of students and recent medical doctors.Methodology and FindingsA cross-sectional survey of 1,223 medical students and doctors was performed in Brazil in 2012. A standardized literature-based questionnaire was applied that gathered preferable or rejected specialties, and asked questions about extracurricular experiences and the influence of 14 factors on a Likert-type scale from 0 to 4. Specialties were grouped according to lifestyle categories: controllable and uncontrollable, which were subdivided into primary care, internal medicine, and surgical specialties. Notably, the time period of rejection was usually earlier than the time period of intended choice (p < 0.0001, χ2 = 107.2). The choice mainly occurred during the internship period in medical school (n = 466; 38.7%). An overall large frequency of participation in extracurricular activities was observed (n = 1,184; 95.8%), which were highly associated with the respective medical area. Orthopedic surgery had the highest correlation with participation in specialty-specific organized groups (OR = 59.9, 95% CI = 21.6-166.3) and psychiatry was correlated with participation in research groups (OR = 18.0, 95% CI = 9.0-36.2). With regard to influential factors in controllable lifestyle specialties, “financial reason” (mean score ± standard deviation: 2.8 ± 1.0; median = 3) and “personal time” (3.1 ± 1.3; median = 4) were important factors. In primary care, these factors were less important (1.7 ± 1.3 and 1.7 ± 1.5, respectively; median = 2 for both), and higher scores were observed for “curricular internship” (3.2 ± 1.1, median = 4) and “social commitment” (2.6 ± 1.3, median = 3).ConclusionThe present findings provide important insights into developing strategies to stimulate interest in specialties based on the needs of the Brazilian healthcare system.

Factors Influencing Medical School Graduates Toward a Career in Psychiatry: Analysis from the 2011-2013 Association of American Medical Colleges Graduation Questionnaire.

Various factors influence choice of medical specialty. Previous research grouped specialties into controllable lifestyle, primary care, and surgical. This study compared factors influencing individuals to choose psychiatry versus other specialties. Data came from the 2011-2013 Association of American Medical Colleges Graduation Questionnaire. The authors grouped responses, ranging from no influence to minor, moderate, and strong influence, into psychiatry and controllable lifestyle, primary care, and surgical specialties and analyzed the data using one-way analysis of variance. The analyses included 29,227 students, of which 1329 (4.5%) elected psychiatry; 10,998 (37.6%), controllable lifestyle specialties; 12,320 (42.2%), primary care specialties; and 4580 (15.7%), surgical specialties. Students choosing psychiatry reported less influence of competitiveness, student debt, and salary expectations than those choosing controllable lifestyle and surgical specialties (p < 0.0001) and more influence of work/life balance than those choosing primary care and surgical specialties (p < 0.0001). They reported less influence of family expectations than those choosing controllable lifestyle specialties (p < 0.0001). They reported more influence of fit with personality than controllable lifestyle, primary care, and surgical specialties (p < 0.004). Students entering psychiatry do not fit the traditional categories of controllable lifestyle, primary care, and surgical profiles, but fall between controllable lifestyle and primary care specialties. Recruitment efforts may need to address this different pattern of influences.

Capsule Commentary on Choi et al., Primary Care Careers Among Recent Graduates of Research-Intensive Private and Public Medical Schools

This study by Choi et al.1 investigated graduates of research intensive and non-research intensive allopathic medical schools to see if there was a difference in the proportion choosing primary care. They found that the answer depended on whether the schools were public or private. Graduates of private, research intensive medical schools were less likely to choose primary care (24 % vs. 33 %) or family medicine residencies (6 % vs. 2 %) than private non-research intensive schools. There was no difference among public medical schools, where 36 % were primary care practitioners and 7–10 % chose family medicine residencies. The authors conclude that research intensive private medical schools should be more actively promoting primary care careers. The reported associations may have been confounded by a couple of factors. First, students may choose to attend research intensive medical schools because they are interested in research. It would have been helpful if the authors looked at the proportion of graduates who pursued research careers. If private research-intensive medical schools are producing a disproportionate number of researchers, then it can be argued they are succeeding in an important function. A second confounder could be that there are no differences in application rates from lower ranked schools for non-primary care positions, just lower rates of successfully matching these programs. This is suggested by a 2010 study found that higher ranked school graduates had a higher match rate than those from lower-ranked programs into “higher-income, controllable lifestyle specialties.”2 There are a number of important roles for our healthcare system. Academic medical centers focus on three primary missions: patient care, medical education and research. Research intensive medical schools focus a great deal of energy (and talent) on research. It may not be inappropriate that they select students who express greater interest (and potential) for research and then expose them to a more intense research curriculum and a faculty heavily invested in research. The consequences of such a process may produce fewer students choosing to do primary care. The issue of workforce development is important. There is a large, robust literature on the failings of the US healthcare system.3 We are producing a generation of proceduralists. There are a number of reasons why this may be so. Prestige, remuneration, career satisfaction, lifestyle, opportunities for academic advancement and research may all help shape the workforce.4,5 If the goal is to increase the number of graduates choosing careers in primary care, there are more powerful forces at play than the orientation of specific medical schools.

Effect of Financial Remuneration on Specialty Choice of Fourth-Year U.S. Medical Students

To investigate whether financial incentives could reverse the trend of declining interest in primary care specialties among U.S. medical students. An electronic survey was sent to all U.S. fourth-year MD and DO medical students in 2009 with a Department of Defense service obligation. Students not selecting a primary care residency were asked if a hypothetical bonus paid before and after residency or an increase in annual salary of attendings in primary care specialties would have resulted in these students selecting primary care. Logistic regression was used to determine student characteristics associated with accepting a financial incentive. The survey response rate was 56% (447/797). Sixty-six percent of students did not apply for a primary care residency. Of these, 30% would have applied for primary care if they had been given a median bonus of $27,500 (interquartile range [IQR] $15,000-$50,000) before and after residency. Forty-one percent of students would have considered applying for primary care for a median military annual salary after residency of $175,000 (IQR $150,000-$200,000). Students who considered primary care but chose a controllable lifestyle specialty (e.g., radiology) were nearly four times more likely to name an influential hypothetical salary than were students who did not consider primary care and chose a noncontrollable lifestyle specialty (e.g., surgery) (67% versus 17%, P < .0001). U.S. medical students, particularly those considering primary care but selecting controllable lifestyle specialties, are more likely to consider applying for a primary care specialty if provided a financial incentive.

Match Rates Into Higher-Income, Controllable Lifestyle Specialties for Students From Highly Ranked, Research-Based Medical Schools Compared With Other Applicants

Factors impacting medical student specialty career choice are poorly understood, but may include income potential and lifestyle features such as limited and predictable work hours. Data from the National Resident Matching Program and the San Francisco Match were used to examine match rates into higher-income controllable lifestyle (CL), lower-income CL, and noncontrollable lifestyle (NCL) specialties from 2002 to 2007. We studied 3 cohorts: students from highly ranked, research-based medical schools, other US senior medical students, and independent applicants (consisting mostly of graduates from foreign medical schools). By 2007, 22.5% of students from highly ranked schools matched into a higher-income CL specialty compared with 16.5% of other US seniors and 8.4% of independent applicants. During the study period, students from highly ranked schools increased their match rate in higher-income CL specialties by 7.9%, while all cohorts experienced declines in match rates for NCL specialties. Compared with other US seniors, students from highly ranked schools were more likely to match into higher-income CL specialties (odds ratio [OR], 1.46; 95% confidence interval [CI]: 1.27-1.68), while independent applicants were much less likely to do so (OR, 0.46; 95% CI: 0.42-0.51). Independent applicants had the highest odds (OR, 2.38; 95% CI: 2.25-2.52) of matching into NCL specialties. All cohorts had declining match rates into NCL specialties from 2002 to 2007. When compared with other US seniors, students from highly ranked schools had the highest odds of matching in higher-income CL specialties, while independent applicants had the highest odds of matching into NCL specialties. These trends are important to consider in light of recent efforts to better balance the physician workforce.

In This Issue

What factors affect specialty selection for US medical school graduates and residency applicants? Can we predict what makes residents successful in their chosen specialties? These questions are of interest to program directors and institutional leaders, and a series of articles in this issue are devoted to resident selection and success in residency and beyond. Patel and colleagues (p 360) report on medical students matching into “controllable lifestyle specialties,” Mahabir and colleagues (p 316) report on factors that contribute to success in matching into a surgical specialty, and Santen et al (p 336) report on potentially discriminating questions during resident interviews and the effect on residents' choice. Wetz and colleagues (p 327) discuss offers outside of the residency match, as well as potential implications for specialty selection, with a commentary by National Resident Matching Program leaders (p 334).Two articles report on research to assess factors that predict successful performance in obstetrics-gynecology (Brustman et al, p 349 and Stohl and colleagues, p 322). Chang et al (p 341) analyze the impact of resident role models on medical student interest in obstetrics-gynecology. Using an Objective Structured Clinical Examination, Lypson and colleagues (p 354) assess the competence of underrepresented minority residents, and Lister et al (p 366) assess the effect of a transition to practice experience for neurosurgery residents.In addition to these works on a “theme,” the issue includes articles on practical interventions in resident education, assessment, and environment and context in a range of medical specialties. Williams et al (p 373) describe geriatrics competencies for internal medicine and family medicine residents, Opar and colleagues (p 404) report on their use of simulation to assess resident performance in caring for patients with acute coronary syndrome and cardiac arrest, Castillo and colleagues (p 449) offer evidence for the value of global health experiences in advancing residents' sensitivity in caring for diverse and economically disadvantaged patients, and Arora et al (p 456) describe a neighborhood health exchange as a means of educating residents and enhancing care for a local patient population.An article and two commentaries discuss the work life and work context of academic physicians. Christmas and colleagues (p 478) report on their assessment of academic clinicians' perceptions of the advantages and challenges of their role. A commentary by Thornburg (pp. 485) and a second commentary by Bush and Nasca (p 488) in the “News and Views” section present added perspectives on the topic.Also in this issue are Hicks and colleagues' (p 410) summary of the work of the pediatrics community to develop educational milestones for pediatrics residents, and an accompanying commentary by Carraccio and colleagues (p 419).The September 2010 issue says farewell to themed issues and introduces Gail Sullivan, MD, MPH, as its editor-in-chief. In her first editorial, titled “Slouching Towards Bethlehem: Journal of Graduate Medical Education as Midwife,” Dr Sullivan describes her vision for the Journal.

Specia alty prefer rences amo ong medic cal studen nts in a Ke enyan univ versity

Specialty distribution in Kenya continues to exhibit gender disparities despite the increasing number of female medical students graduating each year. This study aimed at assessing specialty preferences and factors influencing these choices among male and female medical students in Kenya. Four hundred and fifty medical students, from first to fifth year of study at the University of Nairobi, were each issued a self-administered questionnaire designed to assess their specialty preferences and factors influencing these choices. The specialty preferences were compared with the actual distribution of specialists in Kenya. Data collected were analyzed using Statistical Package for Social Sciences. Three hundred and eighty five (85.6%) questionnaires were completed. Surgery had the highest preference rate followed by pediatrics, internal medicine and obstetrics and gynecology. Significantly more males preferred surgery than females who mainly selected pediatrics (p<0.001). There was an increased likelihood of female students choosing controllable lifestyle specialties. These preferences mirrored the actual distribution of specialists in Kenya. Male students significantly considered prestige in a specialty (p=0.006), while their female counterparts mostly considered ease of raising a family and gender distribution in the specialty (p<0.001). Gender-based similarities and differences exist in factors influencing specialty preferences among Kenyan medical students. These factors may explain the observed specialist doctor distribution in the country.

The Relationship between Specialty Choice and Gender of U.S. Medical Students, 1990???2003

Women have been postulated to be more responsible than men for the recent trend of lifestyle factors influencing the specialty choices of graduating U.S. medical students. The authors looked at the specialty choices of U.S. medical students between 1990 and 2003 to determine whether and to what degree women were responsible for the trends toward controllable lifestyle specialties. Specialty preference was based on analysis of results from the American Association of Medical Colleges' Medical School Graduation Questionnaire. Specialty lifestyle (controllable vs. uncontrollable) was classified using a standard definition from prior research. A random effects regression model was used to assess differences between men and women in specialty choice over time and the proportion of variability in specialty preference from 1990 to 2003 explained by women. Overall, a greater proportion of women planned to pursue uncontrollable specialties compared with men in every year analyzed. Both women and men demonstrated a decreasing interest in uncontrollable lifestyle specialties by almost 20%. However, regression analysis found that women were more slightly more likely to choose an uncontrollable lifestyle specialty compared to men over time (p < .01). Among U.S. medical graduates, women were not more responsible than were men for the trend away from uncontrollable lifestyle specialties over the time period studied. Men and women expressed similar and significant rates of declining interest in specialties with uncontrollable lifestyles.

The Influence of Controllable Lifestyle and Sex on the Specialty Choices of Graduating U.S. Medical Students, 1996???2003

To determine whether the preferences of female medical students are sufficient to explain the recent trend of U.S. medical students choosing specialties with controllable lifestyles. Specialty choice for graduating U.S. medical students by sex was determined from the responses to the Association of American Medical Colleges' 1996-2003 Medical School Graduation Questionnaires. Using earlier research, specialties were classified as having an uncontrollable or controllable lifestyle. Log-linear models were constructed to assess the strength of association among trends in specialty choice, controllable lifestyle, and sex. The percentage of women choosing specialties with controllable lifestyles increased from 18% in 1996 to 36% in 2003. For men, the percentage grew from 28% to 45%. The change in preference for controllable lifestyle specialties accounted for a large proportion of the variability in specialty choices for both women and men from 1996-2003 (chi2 for changes common to women and men = 920, 1 df, p < .0001). The difference between women and men in the trend toward controllable lifestyle specialties was small relative to the common changes (chi2 for differences = 12, 1 df, p = .0005). Controllable lifestyle was strongly associated with the recent trends in specialty choice for both women and men and could not be explained solely by the specialty preferences of women.

The controllable lifestyle factor and studentsʼ attitudes about specialty selection

Questionnaires were distributed to 346 fourth-year students in nine medical schools. The students were asked to state their selected specialty and to rank the importance that each of 25 influences, listed as questionnaire items, had had in making their choice of specialty. Factor analysis showed that particular items were significantly associated with particular factors. The first factor emphasized perceived lifestyle (items in this category gave importance to remuneration, personal time, and prestige); the second factor emphasized cerebral activities and a practice orientation; and the third factor stressed altruistic values and attitudes. The authors classified the selected specialties into three groups: those characterized as having a non-controllable lifestyle (NCL), those with a controllable lifestyle (CL), and surgery. (CL specialties were defined as those that allow the physician to control the number of hours devoted to practicing the specialty.) Data were analyzed using factor analysis, and analysis of variance, and the Scheffé method. Analysis indicated that the perceived lifestyle factor was most closely associated with the responses of those students choosing CL specialties. Furthermore, this factor received the highest total loading of the three factors from all the students, thus indicating the level of interest in lifestyle factors. Responses to items that defined the cerebral and practice factor were highest from the group of students choosing CL specialties and lowest from the group choosing NCL specialties. The NCL students scored highest in the altruism factor and the CL students scored the lowest. The surgery and NCL groups were similar in attitude patterns, and both were substantially different in attitude patterns from those of the CL groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Controllable Lifestyle: A New Factor in Career Choice by Medical Students

To determine whether control of work hours (controllable lifestyle) was becoming an increasingly important factor in choices of specialties by medical students, data from three medical schools over the past ten, ten, and six years, respectively, were reviewed for the types of specialty training entered by students in the top 15% of their classes. Since students in the upper 15% of the class are likely to obtain the specialties of their choice, any change in the pattern of their specialty preferences probably reflects a general trend. Specialties that feature a controllable lifestyle (CL) were defined as anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, otolaryngology, pathology, psychiatry, and radiology. Non-CL specialties were surgery, medicine, family practice, pediatrics, and obstetrics-gynecology. The results showed that the percentages of students entering CL specialties increased significantly at all three schools, the percentages of students entering non-CL specialties decreased significantly at all three schools, and there was no significant change in the percentage of students entering surgical specialties.