In this article career preferences of medical specialists in the Netherlands are analysed, based on a survey among the members of medical associations of ®ve specialties. Four di erent career preferences were o ered, each of which implied a possible variation in working hours. A questionnaire was sent to a random selected group of working specialists in general practice, internal medicine, anaesthesiology, ophthalmology and psychiatry. Logistic regressions were used to predict career preferences. Besides individual characteristics, work and home domain characteristics were taken into the analysis. Not surprisingly, the preference for career change in respect of working hours is higher among full-time MDs, especially women, than among part-time workers. In contradiction to what was expected, home domain characteristics did not predict a part-time preference for female, but for male MDs. One home domain characteristic, children's age, did predict the male part-time preference. Further gender di erences were found in respect of the ®t between actual and preferred working hours (A/P-®t). The majority of male MDs with a full-time preference had achieved an A/P-®t, whereas signi®cantly less female MDs achieved their preferences. It was found that hospital-bound specialists are less positive towards part-time careers than other specialists. Furthermore, the change of working hours would imply a reduction in FTE for all specialties, if all preferences were met. Especially in hospital-bound specialisms it was not con®rmed that the reduction in FTE would be low; this was found only in respect of interns. It may be concluded that individual preferences in career paths are very diverse. Personnel policy in medical specialties, especially in hospitals, will have to cope with changes in traditional vertical and age-related career paths. Flexible careers related to home domain determinants or other activities will reinforce a life cycle approach, in which the centrality of work is decreasing. #

BackgroundFor the further development of palliative care, it is relevant to gain insight into trends in non-acute mortality. The aim of this article is twofold: (a) to provide insight into ten-year trends in the characteristics of patients who died from cancer or other chronic diseases in the Netherlands; (b) to show how national death statistics, derived from physicians' death certificates, can be used in this type of investigations.MethodsSecondary analysis of data from 1996 to 2006 on the "primary" or "underlying" cause of death from official death certificates filled out by physicians and additional data from 2003 to 2006 on the place of death from these certificates.ResultsOf the 135,000 people who died in the Netherlands in 2006, 77,000 (or 57%) died from a chronic disease. Cancer was the most frequent cause of death (40,000). Stroke accounted for 10,000 deaths, dementia for 8,000 deaths and COPD and heart failure each accounted for 6,000 deaths. Compared to 1996, the number of people who died from chronic diseases has risen by 6%.Of all non-acute deaths, almost three quarters were at least 70 years old when they died. Almost one third of the people died at home (31%), 28% in a hospital, 25% in a nursing home and 16% somewhere else.ConclusionFurther investments to facilitate dying at home are desirable. Death certificate data proved to be useful to describe and monitor trends in non-acute deaths. Advantages of the use of death certificate data concern the reliability of the data, the opportunities for selection on the basis of the ICD-10, and the availability and low cost price of the data.

Background: An increasing number of medical specialists prefer to work part-time. This development can be found worldwide. Problems to be faced in the realization of part-time work in medicine include the division of night and weekend shifts, as well as communication between physicians and continuity of care. People tend to think that physicians working part-time are less devoted to their work, implying that full-time physicians complete a greater number of tasks. The central question in this article is whether part-time medical specialists allocate their time differently to their tasks than full-time medical specialists.

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Although medical specialists primarily work full-time, part-time work is on the increase, a trend that can be found worldwide. This article seeks to answer the question why some medical specialists work part-time, while others do not although they are willing to work part-time. Two approaches are used. First, we studied reported reasons and as a second approach we used a theoretical model, based on goal-directed behavior and restrictions. A questionnaire was sent to all internists (N = 817), surgeons (N = 693) and radiologists (N = 621) working in general hospitals in The Netherlands. Questions were asked about personal traits, characteristics of the work situation, and motives for working full-time or part-time. Frequencies were reported for the reasons given, and multilevel analysis was used to test the theoretical model. The results show that the reported reasons for working part-time and being willing to work part-time are the same: the importance of family and leisure pursuits. The second approach showed that medical specialists working part-time tend to be female, older, and have children below the age of five. Surgeons are least likely to work part-time. A willingness to work part-time is purely individual and not related to any of the explanatory variables. We conclude that working part-time is related to both professional and personal circumstances. Policy should be aimed at removing the organizational difficulties that obstruct the realization of part-time work. Alternatively, perhaps there should be a change in working hours for all medical specialists. As the majority of all full-time working medical specialists are willing to work part-time, this might indicate that most medical specialists actually prefer "normal" working hours.