The present study is part of an ongoing prospective survey of a
cohort of Swiss medical school graduates. Subjects included in the
study are fourth-year residents in different medical speciality fields.
The aims of the study are to examine (1) the development of the residents' speciality choices since graduating from medical school and (2) what factors influenced their choices.
Development of the residents' speciality choices: at the
end of medical school a considerable number of students have not yet
developed precise ideas as to which speciality they want to work in.
The main reason is lack of clinical experience. During the first and
second years of post-graduate training they gain insight into various
specialities, which makes it easier for them to make their decision.
Some residents change the speciality they primarily aspired to, but not
so many do. Nor is a marked shift away from one speciality towards
another evident. Compared to the working doctors, significantly fewer
young doctors aspire to become primary care physicians (PCPs) or
psychiatrists. In the competition-based health care systems of
Switzerland and the other German-speaking countries the professional
prestige, social status, and income of other specialists is much higher
than those of PCPs and psychiatrists. As long as the current health
policy does not create better professional conditions, the shift away
from PC and psychiatry will continue. If this trend prevails for some
time, there will be a shortage of doctors providing basic somatic and
mental health care, especially in rural areas.
Factors influencing speciality choice: As hypothesized, we found gender different speciality choices,
female doctors being over-represented in specialities like gynaecology
& obstetrics (G&O), paediatrics, and anaesthesiology and male
doctors in surgical specialities. Similar results are reported in other
studies [11-13,17,34].
Although G&O entails long hours and a heavy surgical workload, a
growing number of women choose this speciality. Women are interested in
surgical specialities, but often experience gender-relevant exclusion
mechanisms in other surgical fields [17,35].
The marked gender shift in G&O is due to the growing attitude,
starting in the late 1980s, that women should be treated by female
physicians [36]. Paediatrics, the other speciality mainly chosen by women, is also a speciality in which gender schemas play a certain role [14]. This gender-distinct speciality choice was already found when the participants were in the last year of medical school [15].
The reasons for an increasing number of female doctors choosing
anaesthesiology might be manifold: anaesthesiology is a professionally
prestigious speciality like surgery but not as competitive, it covers a
broad medical spectrum and offers good options for part-time work and
good promotion prospects, all factors appreciated by females. Whether
the decisive role of gender is based on internalised gender roles or
whether there are open or masked deterrents cannot be distinguished by
this study.
Personality, career motivation, life goals and speciality choice: According
to our assumption, we found that gender, personality, career motivation
and life goals have an impact on speciality choice. Petrides and
McManus [1] described a mapping of medical careers based on the typology found by Holland in careers in general. Holland's theory [37]
suggests that careers can be organised into six broad types, which can
be represented around a hexagon, known by the acronym RIASEC, standing
for 'Realistic', 'Investigative', 'Artistic', 'Social', 'Enterprising'
and 'Conventional'. They also referred to the 'Things↔People' and
'Ideas↔Data' dimensions proposed by Prediger [38]
which can be underpinned to Holland's typology. Both models use the
attribution of the medical specialities based on the characteristics of
their professional activities. We suppose that residents choose a
medical speciality in which they can conduct their professional
activities corresponding to their special personality traits, career
motivation, and life goals aspired to. The residents in surgical specialities in
our study were characterised by high values for instrumentality,
intrinsic and extrinsic career motivation, 'power' and 'achievement' as
life goals. These attributes and attitudes are mainly
'Things/technique-oriented' according to Prediger and can be assigned
to Holland's realistic career type. Participants choosing anaesthesiology and intensive care assessed
themselves almost as highly instrumental as doctors in surgery. They
can also be mapped to the realistic type. Contrary to the study by
Petrides & McManus [1],
the G&O residents in our sample revealed characteristics of 'People
Orientation', matching the social type, a fact which might be
influenced by the high number of females in this group. They stated
high expressiveness and life goals aiming at satisfying social
relationships. Paediatricians in our study, mainly females, showed similar characteristics as the G&Os. Psychiatrists differed
from all the other specialities by rating the extraprofessional
concerns highest, while expressiveness and altruism were not values
very high. They could not easily be assigned to one of the RIASEC
types. The same applies for primary care physicians. They
showed characteristics of 'People Orientation' (high extraprofessional
concerns and altruism), and rated in the medium range in most of the
other aspects. The internists were allocated to the investigative type
by Petrides & McManus [1], a type in which patient-relationships and diagnostic investigations play their part. This might also apply to the internists in
our study; they described themselves as empathetic (adequate
expressiveness), but also instrumentally-oriented. The RIASEC mapping
of medical specialities did not consider career motivation and life
goals but focused only on personality traits. Our results indicate that
career motivation and life goals are even more important for the
speciality choice than personality traits.
In summary, the results of our study indicate that gender plays a
decisive role in speciality choice, while the influence of personality
declines after controlling for career motivation and life goals. The
feminisation of medicine and especially of some specialities can be
expected to lead to fundamental changes in the medical system. One can
assume that the style of leadership in hospitals will change: As long
as men are department heads, a "command and control style of managing
others" will predominate, while women tend towards "interactive
leadership" [39].
Other aspects concern employment: more part-time jobs have to be
provided for women doctors with family obligations. However, the
feminisation also carries the risk of the danger of vertical and
horizontal gender segregation [40]:
female physicians often spend more time with patients while male
doctors look at what is more advantageous for their career, such as
laboratory work, developing research projects and writing papers. These
differences in working attitudes result in gender-different career
opportunities: males taking over leadership positions and females
looking after their patients' needs.
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