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. #

BackgroundThe main subject is the influence of gender and the stage of life on the choice of specialty in medical education. In particular we looked at the influence of intrinsic and external motives on this relationship. The choice of specialty was divided into two moments: the choice between medical specialties and general practice; and the preference within medical specialties. In earlier studies the topic of motivation was explored, mostly related to gender. In this study stage of life in terms of living with a partner -or not- and stage of education was added.MethodsA questionnaire concerning career preferences was used. The online questionnaire was sent to all student members of the KNMG (Royal Dutch Medical Association). 58% of these students responded (N = 2397). Only 1478 responses could be used for analyses (36%). For stipulating the motives that played a role, principal components factor analysis has been carried out. For testing the mediation effect a set of regression analyses was performed: logistic regressions and multiple regressions.ResultsAlthough basic findings about gender differences in motivations for preferred careers are consistent with earlier research, we found that whether or not living with a partner is determinant for differences in profession-related motives and external motives (lifestyle and social situation). Furthermore living with a partner is not a specific female argument anymore, since no interactions are found between gender and living with a partner. Another issue is that motives are mediating the relationship between, living with a partner, and the choice of GP or medical specialty. For more clarity in the mediating effect of motives a longitudinal study is needed to find out about motives and changing circumstances.ConclusionsThe present study provides a contribution to the knowledge of career aspirations of medical students, especially the impact of motivation. Gender and living with a partner influence both choices, but they are not interacting, so living with a partner is similarly important for male and female students in choosing their preferences. Moreover, external and intrinsic motives mediate this relationship to a greater of lesser degree. First stage students are influenced by life-style and intrinsic motives in their choice of general practice. For second stage students, the results show influences of life-style motives next to profession-related motives on both moments of choice.

One of the fundamental tenets of medicine has been the centrality of the profession as a life calling; physicians work long hours and routinely sacrifice personal interests for professional demands. In 1993, only 13% of clinical faculty and 6% of basic science faculty members of U.S. medical schools worked part-time. 1 Historically, female physicians have been more likely than their male counterparts to work less than full time. Yet, despite increasing numbers of women in medicine and increased interest in personal time for self and family, U.S. medical workforce projections have forecast only a 3% decrease in the anticipated full-time equivalent of physicians over the next 10 years. 2 Trends in the general workforce provide a backdrop for changes in U.S. physicians' work hours. Over the past 20 years, full-time employment of women has increased 46%, while part-time employment has increased 88%. In 1988, women were 67% of the parttime labor force and 40% of the full-time labor force in the United States. 3,4 The percentage of women in the first year classes of U.S. medical students increased nationwide throughout the 1990s. These trends would indicate that an increase in interest in part-time work is likely to occur among U.S. physicians.The Netherlands has a health care system that includes prepaid and fee-for-service health care as well as Supported by grants from: