Specialty income and career decision making: a qualitative study of medical student perceptions

Abstract

Context Medical educators in the USA are interested in the ways medical students make career choices because shortages in key specialties, particularly primary care specialties, limit access to care. Although anticipated specialty income is a strong predictor of student interest, no studies have qualitatively explored the reasons why income is important to students. By better understanding students’ perspectives on income and specialty choice, educators can help students make choices that fit their goals and better educate students about the specialties in which the need for expansion is greatest. Methods In 2012, Year‐2 students at one USA medical school were invited to write an essay about how debt and anticipated income levels influence their career choices. A total of 132 essays (response rate: 67%) were qualitatively analysed using a hermeneutic phenomenology approach to conventional content analysis, in which themes emerge inductively from the data. Researchers employed peer debriefing, modified member checking, thick description, code–recode strategies, audit trails and reflexivity to ensure quality and rigour. Although this analysis initially focused on student perceptions of specialty income, prestige also emerged as an important related theme. Results Three major findings emerged. Income is of varying importance to different students. Students value income because it provides freedom and flexibility, and power and security. Students recognise that high income confers social prestige. Students also define specialty prestige in other ways, including match competitiveness, perceived expertise, opportunities for advancement through fellowships, and power and autonomy. Conclusions Medical students’ perspectives of specialty income, specialty choice and prestige are more complex than previously reported. Medical educators should frame conversations about specialty choices in ways that incorporate varied perspectives on income and prestige. Health policymakers should recognise that income and prestige influence medical students’ decisions in complex ways. These insights may inform strategies to counteract shortages in key specialties, including primary care specialties.

Life satisfaction, life quality, and leisure satisfaction in health professionals

“…Because, although there are physical such as musculoskeletal pain and psychological diseases such as fatigue, burnout, depression among health professionals, [26][27][28][29][30] they have high prestige. [31][32][33] Health professionals also face low unemployment rates and are paid relatively higher incomes. 34 These may constitute important factors that increase the socioeconomic status of healthcare professionals and increase their life satisfaction, life quality, and leisure satisfaction levels.…”

Determinants of medical specialty competitiveness

“…17 Research has also recently demonstrated a perception among students linking specialty income and prestige. 18 Using US-graduate fill rate as a measure of competitiveness, neurological surgery, orthopaedic surgery, otolaryngology and plastic surgery were among the most competitive specialties in the 2019 US NRMP match. Among medical students who ranked the factors that influenced their career choice, prestige positively predicted a selection of general surgery (p<0.003).…”

Development of a&nbsp;CanMEDS-based instrument for evaluating medical students’ perceptions of the key competencies of a&nbsp;socially accountable healthcare practitioner

“…However, some of these positive attitudes decline over time [15,16]. Furthermore, the idea of a social contract, an obligation to act altruistically, care for indigent patients, reduce health inequalities, and address priority health concerns is not uniformly endorsed by clinical trainees [17,18], highlighting the critical need to better understand students' perceptions of the attributes of a socially accountable healthcare practitioner and how these may change and evolve over time, both before and after graduation. While we are starting to develop an understanding of what works, there is no robust way to track the process to ensure that we arrive at the desired outcome-graduates who are adequately prepared with the necessary skills and values to respond to the diverse and ever-changing health needs of the population [19].…”