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Archived Comments for: Medical specialty considerations by medical students early in their clinical experience

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  1. The Process of Career Decision-Making

    gary freed, University of Michigan

    2 April 2012

    Achieving the optimal balance of physician specialties and subspecialties in the medical workforce is an important issue for all nations with a well-developed health care system. Economic and personal factors play roles in the decisions of career pathway for those in all aspects of training from undergraduate medical training through fellowship. Different nations have a variety of priorities they may wish to address through efforts to impact specialty choice. Currently, many nations believe they currently have, or will have, shortages of primary care providers for the adult population. For pediatric care, the perceived or expected shortages are actually in subspecialty care. The article by Weissman, et al. highlights several important facets to the decision process of medical students when selecting the choice of specialty for their residency training.

    The biggest question is whether any specific intervention by faculty and/or medical school administration can have a demonstrable impact on specialty or subspecialty choice and how such efforts may be used to conduct policy directives for health care workforce needs. Certainly, societal efforts through financial incentives may be able to have some effect, but their influence will be modulated by other individual priorities. Although cross-sectional studies can help us to understand the factors influencing the decision process at a given point in time, they are less helpful in understanding the process of the decision-making of our trainees and when the actual decision takes place or how often trainees change their mind. Longitudinal studies to demonstrate the dynamic process of career decision-making as it tracks through training are required to fully understand where any interventions may have true impact. Otherwise, we may be subject to our own anecdotal experiences regarding the trainees whom we believe we influenced having a disproportionate impact on our reality.

    Importantly, gender and generational differences are already having an impact on specialty and subspecialty choices across all developed nations. Weissman, et. al. describe some of the issues which appear to have a differential bearing by gender. However, this is not simply a gender-based phenomenon. Other studies have highlighted the different expectations and goals for work hours of recent graduates of both medical and non-medical educational and training programs. These are already having an important impact on choices made by trainees in specialty and subspecialty career decisions. Likely there are also differences across nations with regard to how this phenomenon is manifest.

    As different nations struggle to achieve their desired mix of the specialty and subspecialty medical workforce, they must also realize the ultimate decisions made by the trainees will have an impact not just in the near term, but also far into the future as the trajectories of these careers will play out over several decades. Thus, they must seek to plan for both the short and long term needs of their societies and the role of the different components of their medical system for their populations.

    Sincerely,
    Gary L. Freed MD, MPH
    The Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery
    Director, Division of General Pediatrics, C.S. Mott Children┬┐s Hospital
    Director, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan Health System
    Chair, Smokler Center International Advisory Committee, JDC-Myers-Brookdale Institute

    Competing interests

    None

  2. The importance of getting it right

    Malke Borow, Israeli Medical Association

    8 May 2012

    Weissman et al's article points out the various factors that go into making a decision about career specialty and touches upon the importance of doing this at an early enough stage to make a difference. This point is underscored by data of the Scientific Council of the Israeli Medical Association (IMA), the body responsible for overseeing medical residency in Israel. The data shows that between 12-17% of residents who begin residency switch later on to a different field, on average after the first year and a half. This is obviously a waste of time and resources for both the resident and the system.
    In an effort to better equip students to make an advised decision about their choice of specialty, the IMA Scientific Council held a residency fair last year in Beer Sheva, attended by approximately 250 5th and 6th year medical students and interns. The fair consisted of frontal lectures on topics such as the structure of residency and how to go about choosing a specialty, as well as booths manned by rerpresentatives of almost every specialty and several hospitals in the periphery, in an effort to draw residents to those areas. The feeling was that there was a tremendous thirst for knowledge and information which is, of course, the first step to empowering the student to make the best decision for him or her.
    As the authors note, the recent collective bargaining agreement signed by the IMA will presumably also have an effect on the choice of specialty, as well as the location. Time will tell how strong the link will be.

    Competing interests

    None

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