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This study aimed to investigate the arguments given by Swiss residents for …


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Discussion
- Swiss residents' arguments for and against a career in medicine

In recent years, the image of medicine as a caring profession has been badly tarnished by a rash of critical reports in the media of many Western countries [5,23,24]. Blame for the rising costs of health care is laid mainly at the feet of doctors. To bring costs under control, managed-care bureaucrats increasingly limit the scope of doctors' work and patient care [4,17].

This qualitative study focused on the statements made by the participants of the prospective Swiss physicians' career-development and life-satisfaction study, in favour of or against a career in medicine. At the time of the assessment, the physicians were in the middle of their residency. The responses were evaluated according to Mayring's qualitative content analysis [22] and assigned to eight content categories.

Looking first at the ranking and frequency distribution of residents' responses, it is striking that the categories Personal experiences in day-to-day working life and Interpersonal experiences accounted for 70% of all comments in favour of a career in medicine. This indicates that most female and male physicians have chosen medicine because they have a high interest in the scientific and practical matters of the profession and are devoted to caring for people. Similar results are reported by McManus et al. [25]. Fourth-year residents seem to enjoy the practical experience of working as doctors with patients and value the interdisciplinary teamwork among the medical staff. In a previous assessment (T2), when the participants were in their first year of postgraduate training, statements concerning both positive and negative experiences of professional relationships were also ranked high [20]. The top-ranking statements against a career in medicine were the responses in the category General work-related structural conditions (32%). Heavy workload, on-call responsibilities and lack of mentorship and departmental support as well as increasing bureaucracy are disincentives to staying in clinical work [26]. Women doctors in particular complain that the current job-structure framework has a lasting negative effect on their career opportunities as soon as they attempt to balance their professional and personal lives [27]. Second place in the ranking of arguments against a career in medicine is taken by Social prestige and health-policy aspects (21%). To our knowledge, only a few studies have addressed these issues as deterring young doctors from remaining in curative medicine [5]. Accused by the media and health politicians of being greedy for power and money, doctors are often forced to legitimate their work on economic rather than scientific or ethical grounds. Because of increasing financial cutbacks and regulations passed by the government, doctors are restricted in their free professionalism and cannot properly plan their future basis of existence.

For male residents the latter reasons are even more important as arguments against a career in medicine than for female residents. Not surprisingly, there were few or almost no positive statements from either gender concerning Income and Leisure/Private Life. In terms of negative arguments in these categories, female residents made significantly fewer comments for Income, but more comments for Private Life. These assessments still reflect the gender stereotypes of men needing to provide financial support for their family while women identify more strongly with the caring aspect [28].

What makes the medical profession still attractive enough for young people so that a high number of school leavers apply for medical school? Study participants' statements, listed in Table 2 (see also Additional file 1), indicate that the bio-psychosocial profile of human medicine [29], the broad, interdisciplinary scope of academic medicine and the wide range of options for working as a doctor are key factors for the profession's appeal. A British study [25] also reported that the generic motivations of medical school applicants could be assigned to four dimensions: Indispensability, Helping People, Respect and Science. Unlike economics and fine arts, professional fields in which job security has decreased, the medical profession still provides a high degree of job security.

The arguments against a career in medicine mentioned above illustrate why men in particular have a declining interest in medicine: Badly structured residency programmes, heavy workload and inadequate wages are conditions which young physicians are no longer willing to accept. As seen in Great Britain [3] and Germany [18], an increasing number of medical-school graduates leave curative medicine, go abroad to countries with better working conditions [6], or express their dissatisfaction in demonstrations (Switzerland) or strikes (Germany).

Several decades ago, doctors tended to over-commitment to their jobs and neglect of their families. Nowadays, young physicians insist on a higher quality of life and more flexibility to arrange their personal lives according to their own tastes.

Contrary to the findings in the literature, we noted only a few differences in residents' statements depending on different medical fields. This result might be explained by the fact that unsatisfactory basic structural conditions of the profession are a major deterrent irrespective of the medical field. In surgical fields in particular, continuing education is often poorly structured [10,11,20,26], which leads to a declining interest in this field. In our study, High-technology medicine and Psychiatry residents gave significantly more arguments against a career in medicine in the Quality of postgraduate training category. It is probably safe to assume that the speciality-qualification programme guidelines are not properly implemented in these two medical fields.

That one in every five of the participating fourth-year residents would not choose to become a doctor all over again must be a cause for concern. Among the statements given against a career in medicine were a lack of enjoyment and fulfilment in patient care, and the experiencing of difficulties in day-to-day working life. At this point in their careers, it is unclear whether the aforementioned arguments against choosing a career in medicine will become so important that the residents leave medicine, or whether they will be able to cope with the unsatisfactory structural conditions of the medical profession and with the restrictions imposed by health policies. It is known that in other countries, especially Germany, a high percentage of doctors – more women than men – leave medicine after only the first year of clinical work [18]. Considering the high educational investments made in medical school graduates, in most European countries paid primarily by the government, better structural conditions in medicine must be established in order to retain the appeal of the profession.

Further assessments within the scope of the ongoing survey will contribute to answering the question of what careers the participating physicians will pursue in the long run.


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