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Influences on choice of medical career

Queens university library

Although academic research has examined medical career intentions, relatively little research into the decision-making process for doctors exists with the potential to influence policy makers. We need to be able to answer not only the question ‘what sort of career do doctors want to have?’ but also ‘why do doctors choose one career over another?'

By understanding what motivates doctors to work in particular places, structures, or roles, and what deters them from working in others, we are better placed to answer questions around recruitment and retention difficulties in certain specialties and locations, and how we might address these.

 

What has the BMA done so far?

Since 2016, the BMA's public health and healthcare research team has attempted to understand the factors that influence doctors' career choices. We have held qualitative focus groups with doctors, and ran an initial survey to shape our thinking.

We organised our conversations with doctors on a chronological path - starting with the decision to study medicine and finishing with priorities in later career. Using doctors’ own feedback, we assembled a comprehensive survey of the factors that influence choice of medical career.

This survey provides a very insightful overview of the changing nature of doctors’ priorities over a career. But it doesn’t tell the whole story. We are taking this research forward by testing which factors doctors might be prepared to ‘trade-off’ against one another, their compromises indicating which issues are really important to them.

 

Key findings

  • As students, many doctors choose medicine as a career because of its social value and the opportunity to help others.
  • Factors such as earnings and status are not major considerations early on and have a generally minor influence on subsequent career decisions.
  • Through training placements and in choice of specialty, doctors need to satisfy a keen desire for enjoyable and varied work, where preferences for certain skills and patient contact is valued most.
  • Living in a preferred location is critical to the choice of post after a period of training. For many, this is likely to be at least if not more important than the post alone.
  • Prioritising a positive work-life balance becomes more important as a career develops.
  • By later career, a favourable work-life balance is viewed as essential. However, work-life balance needs to be better defined – its meaning may vary within and between professions.

Read more about the results of the survey at different career stages below.

 

  • Choosing medicine

    Career choice graphs

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    Although the reasons doctors give for choosing to enter medicine may not seem the most relevant to their later career decisions, they are worthy of note because they suggest certain values that shape doctors’ professional and ethical outlook and career needs.

    Doctors (when prospective students) told us they were mostly driven by factors like the desire to help others. A frequently held view in our focus groups was that medicine had a transformative social value. This is reflected too in the survey.

    Academic development at school was clearly significant, although male respondents were more likely to cite the importance of the intellectual challenge of medicine and females more likely to be motivated by helping other people.

    Earnings and status were not strong considerations at this early point, although they were present in the survey at every stage.

  • Choosing training placements

    Career choice graphs

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    The period of choosing and changing training placements was seen as an experimental phase of ‘becoming a doctor’. Doctors choose specialty placements which explore their educational and practical needs. Finding enjoyment in training was clearly important, as were biases towards certain skills.

    There were some differences across the groups within the survey. Females were more likely to say they prioritised patient contact and males intellectual challenge. Similarly, current GPs put patient contact and work-life balance higher in their list of priorities.

    A lack of opportunity to experience other specialties was not a significant issue, though with more current juniors in the survey this outcome may have been different, as this is something we hear about.

  • Choosing a specialty

    Career choice graphs

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    Doctors' reasons for their choice of specialty echo their reasons for choosing training placements. For example, variety becomes even more desirable when choosing a specialty.

    This could be due to the decisiveness of this choice. Once a specialty is chosen, variety must come from within ‘the job’ - with the frequent changes of training consigned to the past.

  • Choosing a first post after training

    Career choice graphs

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    Following our focus groups, it became clear that preferred location in which to live was an important consideration for doctors who had completed a period of training and wished to get on in their career.

    Although over half of respondents endorsed this view in the survey, there are multiple dimensions to ‘location’ and we may need to do more work to explain this.

    For example, are doctors motivated by wanting to live in an urban or rural location? Are they influenced by the distances they have to travel to work? Do they value access to communications where they live? There are many questions to consider.

    Also at this career stage, achieving a positive work-life balance moves up the order of priorities - especially for female respondents.

  • Mid career posts

    Career choice graphs

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    Enjoyment is less prioritised at this career stage, but opportunities for career development and achieving a positive work-life balance grow in importance. At a stage when doctors are attempting to develop their career and protect the boundaries between work and home, this is both empowering and practical.

    Preferred location remains the most important influence, while place of work factors are more significant in terms of typical working conditions and reputation.

    Female and less than full time respondents were most likely to say they did/would prioritise a partner’s career or the care of children at this stage than males or full time doctors, but these were not the most frequently reported issues.

  • Later career

    Career choice graphs

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    Later in their careers, work-life balance is even higher up doctors' order of priorities. For many, it is now the most significant issue.

    This might not seem surprising, as factors like career development are unlikely to be high priorities near the end of a doctor’s career. However, it's unclear exactly what work-life balance means to different doctors. For some, it could mean working less than full time. For others, the ability to leave work at the door when arriving home, or reduced on call responsibilities.

    At this career stage, doctors were asked about factors such as the ability to revalidate within their post. We knew from earlier focus groups this could be a consideration. However, the longer term practical effects of revalidation are still hypothetical. It is likely that few doctors currently envisage this as a major issue.

    Elsewhere, potential earnings and financial security become significant issues for the first time. Most of the survey does not show these factors are high priorities for doctors. In later career however, it's plausible that doctors think more about pensions and savings.