Percent of Physicians That Would Choose Their Specialty Again
BMC Med Educ. 2016; 16: 125.
What predicts doctors' satisfaction with their chosen medical specialty? A Finnish national written report
Teppo J. Heikkilä
Unit of Primary Health Care, Hospital District of Northern Savo, P.O. Box 1777, FI 70211 Kuopio, Republic of finland
Harri Hyppölä
Emergency Section, Kuopio University Infirmary, P.O. Box 1777, FI 70211 Kuopio, Republic of finland
Jukka Vänskä
Finnish Medical Association, P.O. Box 49, FI 00501 Helsinki, Finland
Hannu Halila
Finnish Medical Association, P.O. Box 49, FI 00501 Helsinki, Finland
Santero Kujala
Finnish Medical Association, P.O. Box 49, FI 00501 Helsinki, Finland
Irma Virjo
Department of Full general Exercise, School of Medicine, University of Tampere, Kalevantie 4, FI 33014 Tampere, Finland
Markku Sumanen
Section of General Practice, School of Medicine, University of Tampere, Kalevantie iv, FI 33014 Tampere, Finland
Elise Kosunen
Department of General Practice, Schoolhouse of Medicine, University of Tampere, Kalevantie 4, FI 33014 Tampere, Finland
Kari Mattila
Centre of General Practice, Pirkanmaa Hospital District, P.O. Box 2000, FI 33521 Tampere, Finland
Received 2015 Nov 30; Accepted 2016 Apr 19.
Abstract
Background
In Finland the number of medical specialists varies between specialties and regions. More regulation of the post-graduate medical training is planned. Therefore, it is of import to clarify what predicts doctors' satisfaction with their called specialty.
Methods
A random sample independent 50 % of all Finnish doctors nether seventy years of age. The respose charge per unit was 50.5 %. Working-age specialists were asked to value their motives when choosing a specialty. They were also asked if they would choose the aforementioned specialty again. The odds ratios for not choosing the aforementioned specialty over again were tested.
Results
Diversity of work was the nearly important motive (74 % of respondents). Seventeen percent of GPs would non choose the same specialty again, compared to 2 % of ophthalmologists and 4 % of pediatricians. A major function of Diversity of work and Prestigious field correlated with satisfaction whereas Risk with dissatisfaction with the specialty.
Give-and-take
Motives and problems related to the work and training best correlate with satisfaction with the specialty.
Conclusions
When the numbers of Finnish postgraduate medical training posts become regulated, a renewed focus should be given to finding the nigh suitable speciality for each doctor. Information about employment and career advice should play an important role in this.
Groundwork
As the population – and also health intendance personnel – are ageing, major challenges will emerge in meeting the need of equal wellness care services for the unabridged population [1–iii]. In Finland information technology was recently found that the problems apropos a sufficient number of medical specialists in the future are going to vary greatly in different medical specialties and also in dissimilar regions [4, 5]. For example, psychiatric disciplines seem to take issues in having enough specialists in the whole Finland while some surgical specialties are at chance of excess of specialists at least in some areas. One of the main reasons for this workforce imbalance is that in Finland, in practice, a doctor has been able to choose the specialty he or she prefers without any restrictions.
It has been establish that an interest in people is the almost important factor when a young student is entering medicine [half-dozen, 7]. Furthermore, the content of the piece of work too seems to direct the choice of specialty during studies [eight]. However, the idea of future medical specialty is not stable during undergraduate studies and information technology can exist seen as a process that evolves during medical grooming [9–11]. Even after that, the option of medical specialty is non always stable and the stability of the option besides varies between specialties [12].
The career satisfaction of a medico is a complex question. It may exist affected by, for example, workload, workplace stress, organisation of the work, quality of care and ability to access quality services for patients and fair distribution of rewards [13–22]. There are likewise differences betwixt specialties in the importance of different factors explaining job satisfaction [22, 23].
In Finland, 60 % of all working-historic period doctors and 81 % of working-age doctors over 45 years old are medical specialists [24, 25]. Of all specialists, 24 % have two or more specialties (Finnish Medical Association, unpublished data). Females comprise 59 % of all working-age doctors and 57 % of medical specialists [26]. Only 1 % of immature Finnish doctors do not intend to specialize [27].
Because of the imbalance of medical specialists noted recently, there are now plans to develop a new choice procedure for postgraduate medical training so that the imbalance can be corrected [28]. This is a part of other plans stated afterward a most decade-long debate about developing postgraduate medical and dental didactics in Finland [28–30].
In this present state of affairs in Finland, it is important to find out how medical graduates tin can be directed to choose specialties where in that location is shortage of specialists in a way that ensures that they are also motivated and will stay in that detail career path. The aim of this study was to discover out what the main reasons are for choosing a medical specialty and whether there are whatsoever correlations betwixt these motives and dissatisfaction with the chosen specialty.
Methods
The Md 2013 study was undertaken equally a collaborative projection of the University of Eastern Finland (formerly University of Kuopio), the University of Tampere and the Finnish Medical Clan [31]. It followed previous studies conducted in 1988, 1993, 1998, 2003 and 2008. The study compiled data on social background, piece of work history, labour marketplace and career plans in the medical profession in Republic of finland. It besides assessed doctors' views of undergraduate and specialist training, values and professional identity. The questions were mostly formed before the first study in 1988, although some new questions have been added in later on questionnaires. Virtually of the questions used in the inquiry accept existed in the same grade since the commencement questionnaire, for reasons of comparability. In the 2013 study, both postal and electronic questionnaires were used. Addresses were collected from the database of the Finnish Medical Association, which has details on all doctors licensed in Finland. The basic study population in the Medico 2013 study was comprised of all Finnish doctors under 70 years of historic period (North = 21,501). A random sample of approximately 50 % was drawn from this basic report population based on the subjects' birthdays and then that simply those born on odd-numbered days were selected for the sample (n = ten,600). The formation of the data is presented in Table1.
Table 1
Forming the data of the Physician 2013 study
| Study population | 21,501 |
| Study sample | ten,600 |
| Returned questionnaires | |
| 2148 | |
| - Posted | 3202 |
| - In total | 5350 |
| Response rate (%) | fifty.v |
The response rate of women (53 %) was higher than the response rate of men (46 %). The response rate varied in different historic period groups, being the lowest in the group of 35–44-twelvemonth-old respondents. Medical specialists (55 %) also answered more than often than unspecialised doctors (43 %). To command possible non-response bias and to improve the representativeness of the results, age, gender and specialization status distributions of all Finnish doctors were used to calculate weights to each survey respondent. People in under-represented groups were given a weight greater than i and those in over-represented groups were given a weight smaller than 1, with the weighting being proportionate to the caste of over- or under-representation.. The distributions apropos all Finnish doctors were derived from the register of Finnish Medical Association. For the analysis of this study, the working-age medical specialists were selected from the weighted information.
The respondents were asked: "If y'all are a specialist or in specialist training, to what extent did the following items touch your choice of specialty?" and they were presented with 11 items which could have influenced their pick. This same question has been asked in the previous studies. The data were classified by means of a Likert five-point scale. The respondents were also asked: "If you were making the selection again, would you still choose the same medical specialty?"
The respondents were grouped based on gender, age, working sector, specialty and university of specialist training. The information were analysed using cross-tabulation and a Chi-squared test to exam differences between different groups of doctors if they would have chosen a different specialty if making the option again. To calculate odds ratios (with 95 % confidence intervals) for the risk of answering "No" to the question "If you were making the choice again, would you all the same choose the same medical specialty?" a binary logistic regression model was also fabricated with gender, age, items named equally of import motives for choosing a specialty by more than than 25 % of the respondents, correspondence between specialist grooming and electric current work, working sector and specialty equally independent variables. Nagelkerke'due south R-squared and Hosmer-Lewenshow tests were conducted for the logistic regression model. The data were analysed using IBM SPSS 22.0.0.0 for Macintosh predictive analytics software.
Results
The almost frequent motive for choosing a specialty was Diversity of work, followed past Good case gear up by colleagues in the specialty, Positive experiences in the specialty during undergraduate training and Good prospects of employment (Fig.ane).
Motives to cull a medial specialty in Physician 2013 Study. Proportions (%) of working-historic period medical specialists who answered "Considerably" or "Very much" to the question "If you lot are a specialist or in specialist preparation, to what extent did the post-obit items affect your choice of specialty?" in Physician 2013 study (due north = 2796)
When the answers of male person and female person respondents were compared, there were some meaning differences in the motives for choosing a medical specialty (Fig.2). Prestigious field, Opportunities for career development, Opportunity to gain a skilful income, Opportunity to carry out research, Opportunities to work in the private sector and Positive experiences in the specialty during undergraduate training were significantly more of import motives for male respondents. On the other hand, Good opportunity to balance family and work, Reasonable on-call load and Opportunity to control the amount of work were more important for female person respondents.
Differences between male and female doctors when choosing a medical specialty. Differences of proportions (%-units) of working-age male and female medical specialists who answered "Considerably" or "Very much" to the question "If you are a specialist or in specialist preparation, to what extent did the following items touch your choice of specialty?" in Dr. 2013 report. **p <0.01, *p <0.05, males n = 1256 and females due north = 1540
Of all the respondents, 12 % would not have chosen the same specialty if making the choice again (Tabular array2). There was no significant difference betwixt genders. Older doctors would not have chosen the same specialty more ofttimes compared with younger doctors.
Table ii
Proportions of those respondents who would not choose the same medical specialty again
| Answered "No" | |||
|---|---|---|---|
| n | % | ||
| Gender | Males | 1174 | 12.1 |
| Females | 1438 | 11.9 | |
| Age** | Under 45 y. o. | 958 | 6.viii |
| 45–54 y. o. | 936 | 13.3 | |
| 55–64 y. o. | 717 | xiv.5 | |
| Working sector* | Specialized medical care | 1299 | 10.7 |
| Primary wellness care | 392 | eleven.v | |
| Public institutions | 172 | 14.0 | |
| Private sector | 656 | 13.1 | |
| University of specialist training | Helsinki | 834 | 12.nine |
| Kuopio | 324 | 12.3 | |
| Oulu | 427 | 13.8 | |
| Tampere | 523 | 9.9 | |
| Turku | 365 | 9.9 | |
| Foreign university | 37 | 10.8 | |
| Specialty** | General Do | 395 | 17.4 |
| Anaesthesiology and intensive care medicine | 196 | 16.3 | |
| Other Specialties | 390 | 14.9 | |
| Psychiatry | 284 | 14.1 | |
| Occupational Health | 178 | 12.9 | |
| Otorhinolaryngology | 79 | 10.1 | |
| Obstetrics and gynaecology | 139 | nine.2 | |
| Radiology | 99 | 9.i | |
| Internal medicine | 243 | 9.0 | |
| Surgery | 298 | 8.7 | |
| Neurology | 61 | half dozen.6 | |
| Paediatrics | 155 | 4.5 | |
| Ophthalmology | 90 | ii.2 | |
| All together | 2612 | 12.0 |
Proportions (%) of the respondents answering "No" to the question "If you lot were making the choice once again, would you even so cull the same medical specialty?" of working-age medical specialists by gender, age, working sector, specialty, and university of specialist training in Physician 2013 study. Specialized medical care: academy infirmary, other public hospital. Master health care: wellness heart, public occupational wellness care. Public institutions: government agency or institution, university. Internal medicine: cardiology, clinical haematology, endocrinology, gastroenterology, infectious diseases, internal medicine, nephrology, rheumatology. Surgery: cardiothoracic surgery, gastroenterological surgery, full general surgery, paw surgery, oral and maxillofacial surgery, orthopaedics and traumatology, paediatric surgery, plastic surgery, urology, vascular surgery. Psychiatry: adolescent psychiatry, kid psychiatry, forensic psychiatry, psychiatry. Other specialties: child neurology, clinical chemical science, clinical genetics, clinical microbiology, clinical neurophysiology, clinical pharmacology and pharmacotherapy, clinical physiology and nuclear medicine, dermatology and allergology, forensic medicine, geriatrics, oncology, pathology, phoniatrics, physical and rehabilitation medicine, public health, respiratory medicine and allergology, sports medicine. **p <0.01, *p <0.05
The differences between doctors working in dissimilar working sectors were rather small, but statistically significant. A smaller proportion of doctors working in specialised medical care answered "No" to the question "If you were making the choice again, would you yet choose the same medical specialty?" compared with the doctors in primary health care, the private sector and public institutions.
Virtually one-fifth of specialists in full general do and anaesthesiologists would choose a dissimilar specialty if making the selection again, while only fewer than 5 % of paediatricians and a niggling over 2 % of ophthalmologists were not satisfied with their choice of specialty. There were no statistically significant differences between universities of specialist preparation among those who would non choose the same specialty once again.
In the binary logistic regression model, when odds ratios for the risk of answering "No" to the question "If you were making the choice again, would you still choose the same medical specialty?" were calculated, at that place was no statistical deviation betwixt genders. The age groups of 45–54-yr-old and 55–64-year-old respondents had a higher odds ratio to answer "No" compared with the under-45-year-old respondents (Table3).
Table 3
Odds ratios for not choosing the aforementioned medical specialty again
Odds ratios in binary logistic regression model with 95 % confidence interval for working-age medical specialists answering "No" to the question: "If you lot were making the selection again, would you still cull the same medical specialty?" in Doctor 2013 study. Statistically significant (p <0.05) values are in BOLD
When looking at the different motives affecting the choice of a medical specialty, the only differences came in Multifariousness of piece of work, Past take chances and Prestigious field. The respondents who felt that Diversity of piece of work and Prestigious field were of import motives for choosing a specialty had a lower odds ratio to answer "No" to the question "If yous were making the choice again, would you lot still cull the same medical specialty?" compared with the respondents who regarded these motives less important. The respondents who felt By chance was an important motive had a higher odds ratio to respond "No" than the others.
The respondents who reported Practiced correspondence between specialist training and electric current work had a significantly lower odds ratio to answer "No" to the question "If you lot were making the choice over again, would y'all still choose the same medical specialty?" compared with the other respondents. Doctors working in primary health care had a significantly lower odds ratio to answer "No" compared with doctors working in specialized medical care and in the private sector.
Full general practitioners' odds ratio to respond "No" to the question "If you were making the choice again, would you still cull the same medical specialty?" was significantly higher compared with internists, ophthalmologists and paediatricians.
Discussion
Co-ordinate to this study, the motive to choose one'due south medical specialty that best correlated with satisfaction with the chosen medical specialty was Multifariousness of work. Another principal finding was that Correspondence betwixt specialist training and current piece of work had a significant correlation with satisfaction with the specialty. A major role of Chance in selection of the specialty correlated with dissatisfaction with the specialty. Motives of males and females to choose a specialty differed significantly.
Diversity of work was the main motive for choosing a specialty, equally information technology was as well in the previous Md 2008 study [32]. However, medical students' first experiences of colleagues and the content of the particular specialty also seem to accept a major office in option of the specialty [iii, 32–36]. It is also noteworthy, although natural, that doctors desire to evaluate possibilities for future employment when choosing a medical specialty.
In this study, 12 % of the respondents would not have called the aforementioned medical specialty if making the choice now. This ways that a big majority of the specialists were actually quite happy with their choice. Still, even though the proportion of dissatisfied specialists was rather minor, it was notable. Besides, information technology has to be noted that there were some significant differences between specialties in this matter, revealing that despite the quite good overall situation, there are some specialties that would need some attending. Specialists in general practice, in detail, had a significant odds ratio to exist dissatisfied with their medical specialty compared with another specialties. On the other paw, working in master wellness care reduced the odds ratio of dissatisfaction with the specialty. At outset glance in that location seems to exist a discrepancy in these findings, since when examined independently, respondents working in primary health care were somewhat more dissatisfied with their specialty than those working in specialised medical care. I caption for this might be that in Finland medical specialists, especially specialists in full general practice, work in many different fields of medicine, and therefore too satisfaction with the specialty may vary accordingly. For example, approximately xxx % of Finnish specialists in full general practise work outside of principal health care, and approximately 25–thirty % of specialists working in main wellness care have a specialty other than general practice (Finnish Medical Association, unpublished information). Therefore, it might exist that other specialists working in primary health care are especially satisfied with their career path. Nonetheless, the reasons behind this finding would definitely need some further examination.
For females, motives related to work-family balance were more than important, while male person respondents preferred motives related to the external factors of work life, such as career, professional appreciation and salary. For females, flexibility and quality of life seem to be important factors when choosing their medical career, fifty-fifty when it means compromising professional achievements [37–41]. On the other mitt, differences in controllable lifestyle, on-call work and work-family residual play a more meaning function than formerly in a young dr.'s career decisions, also amidst young male doctors [42–44]. Yet, according to this study, gender or motives related to a controllable lifestyle do not seem to correlate with satisfaction with the chosen specialty. Nevertheless, it is important to have them into consideration when developing the selection process and content of postgraduate medical education for the younger generation of doctors. Even so, the youngest group of respondents seemed to be the most satisfied with their specialty. The reasons for this are not clear. It is possible that members of the younger generation have chosen their career more advisedly and truly are more satisfied with their medical specialty. But this may besides point, for example, that one gets more disquisitional towards own choices in later stages of 1's career.
Perceived quality of the specialist training plan had a very small role in the choice of medical specialty. Notwithstanding, at the same fourth dimension Correspondence of the specialist training to the electric current work significantly predicted satisfaction with the chosen specialty. It seems that medical educators should be able to meliorate reveal the content of the postgraduate medical training besides as the content of the work as a medical specialist.
The forcefulness of this report is that it provides national data on Finnish working-age medical specialists. Withal, there are obviously some limitations. First of all, when the get-go report in this series was conducted in 1988, there were few other studies addressing this issue or requirements to validate the questionnaire. Since and then the questionnaires take been largely the same in society to achieve comparability. With questionnaires of this kind, one needs to acknowledge possible bias stemming from the respondents' self-reporting. In some cases respondents may consummate the questionnaire differently when they know the results are going to be seen. Answering "No" to the question near choosing the same medical specialty now does non indicate whether the respondent really intends to seek some other specialty. No assumptions can therefore be fabricated in this direction. Instead, our interpretation is that it indicates dissatisfaction with the called specialty, and has been used as such in this study. The terms used in the study were non explained in the questionnaire. Therefore, we cannot be absolutely sure how the respondents understood the meaning of, for example, Variety of work as a reason to choose a specialty. Withal, this should not take any major affect on the conclusions of this study.
In this study the respondents had to think back to the time when they were deciding which specialty training program they would cull and try to recollect their reasons at that time. It has been reported that important life events remain fairly well fixed in memory [45]. Since the choice of professional person career tin can be considered such an event, one can assume that items related to information technology are well recalled.
Conclusions
As mentioned before, there is an urgent need in Republic of finland to evaluate and regulate the number of postgraduate trainees in medical specialty training programmes. However, the real challenge hither is to combine this with the fact that nether the electric current situation most specialists are actually quite happy with their option of specialty. To exist satisfied with their careers, doctors should continue to be able to find a speciality that they find interesting and that suits their personality and life [46, 47]. At the aforementioned time, the role of take a chance should be kept equally minimal every bit possible. To do this, career guidance should take a office during medical schoolhouse and also afterwards graduation [36]. Medical students and graduates should besides exist kept well informed about the present employment situation in each specialty, then that they tin can take information technology into consideration and, if necessary, requite idea to some other specialty than their first choice. Also interviews might aid in the selection process [48–50]. The importance of first working experiences and the instance fix by colleagues is something that needs to be looked at closely, especially in specialties that are lacking a sufficient workforce. Furthermore, correspondence to the content of the work as a medical specialist should exist the main target when developing the postgraduate medical training to meet the demands of the 21st century.
Ideals approval and consent to participate
Non applicaple. Co-ordinate to Ideals Committee and based on the Finnish Medical Research Act and Personal Data Act, studies of this kind exercise not need upstanding approval, since they exercise not affect the respondent's personal integrity and as respondents are costless to choose whether to respond or not. Respondents were fully informed virtually the use of the questionnaires in the cover messages. Because of this it was presumed that respondents gave an informed consent when choosing to reply the questionnaire.
Availability of information and materials
The information of this written report is available upon asking from the authors.
Funding
This report has been partly funded by the Finnish Ministry of Social Affairs and Health. The funding has been used for costs associated with carrying out the drove of the data. The ministry has non have whatever office in design, analysis or interpretation of this written report.
Footnotes
Competing interests
The authors declare that they take no competing interests.
Authors' contributions
TJH has been principally responsible for writing and preparing this newspaper, and he is the corresponding author. HHy has made a major contribution to the design and editing of this newspaper. JV has significantly contributed to the design and editing of this paper peculiarly in the statistical issues. HHa has played an important part in the design and editing of this paper. SK has played an important part in the pattern and editing of this paper. IV has played an important part in the pattern and editing of this paper. MS has played an important part in the blueprint and editing of this newspaper. EK has played an important part in the design and editing of this newspaper. KM has played an of import part in the design and editing of this newspaper. All authors have read and approved the last manuscript.
Authors' data
Teppo J Heikkilä, Doc, works in this study group as a researcher in Unit of General Practice in the Hospital Commune of Northern Savo. He works too as a senior medical officer in Ministry of Social Diplomacy and Wellness. He is specializing in public health medicine.
Harri Hyppölä, MD, PhD, has specialized in public health medicine, internal medicine, and acute medicine. He works as a master physician in the Emergency Department of the Kuopio University Infirmary. The topic of his thesis in 2001 was undergraduate medical pedagogy in Finland. He is likewise offshoot professor of wellness care administration at the University of Tampere.
Jukka Vänskä has educational background in social sciences (Chiliad.Soc.Sc). He works as research master at the Finnish Medical Clan. Vänskä has published several manufactures on physicans' education, employment and working weather condition.
Hannu Halila, MD, PhD, is deputy chief executive officer at the Finnish Medical Association and a specialist in obstetrics and gynaecology. He is also adjunct professor of wellness care administr ation at the University of Helsinki and past president of UEMS (European Matrimony of Medical Specialists).
Santero Kujala, MD, is medical councellor and a old deputy chief executive officer of the Finnish Medical Clan. He is a specialist in both occupational health and in full general practice.
Irma O. Virjo, MD, PhD, is specialist in general exercise and former Professor of Full general Practice at the Medical Schoolhouse of the Univeristy of Tampere, retired in 2010. She has for many years been developing medical education on undergraduate and postgraduate level. She has also washed research on medical education.
Markku Sumanen, Md, PhD, is a specialist in general practice. He works as an Acquaintance Professor of General Do at the Medical School of the Academy of Tampere. He has developed medical teaching on undergraduate level and has received the special competence in medical pedagogy.
Elise Kosunen, Physician, PhD, works as a Professor of Full general Practice at the Medical Schoolhouse of the University of Tampere. She has developed medical education on both undergraduate and postgraduate level.
Quondam Professor Kari Mattila, MD, PhD, is founder member of the projection studying medical profession since the year 1988. He is a specialist in general practice and public wellness. His special interest is vocational grooming in primary wellness intendance. He has worked since 1975 every bit teacher in the universities of Tampere and Turku.
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