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Study on Medical Specilties That Would Not Pick It Again

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What predicts doctors' satisfaction with their chosen medical specialty? A Finnish national report

  • Harri Hyppölä2,
  • Jukka Vänskä3,
  • Hannu Halila3,
  • Santero Kujala3,
  • Irma Virjo4,
  • Markku Sumanen4,
  • Elise Kosunen4 &
  • Kari Mattila5

BMC Medical Didactics volume 16, Commodity number:125 (2016) Cite this article

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Abstract

Background

In Republic of finland the number of medical specialists varies between specialties and regions. More than regulation of the mail-graduate medical training is planned. Therefore, information technology is important to clarify what predicts doctors' satisfaction with their chosen specialty.

Methods

A random sample independent 50 % of all Finnish doctors under lxx years of historic period. The respose rate was 50.5 %. Working-age specialists were asked to value their motives when choosing a specialty. They were also asked if they would choose the same specialty again. The odds ratios for not choosing the same specialty once again were tested.

Results

Variety of work was the most important motive (74 % of respondents). Seventeen percent of GPs would non choose the same specialty once again, compared to 2 % of ophthalmologists and 4 % of pediatricians. A major part of Diversity of work and Prestigious field correlated with satisfaction whereas Chance with dissatisfaction with the specialty.

Discussion

Motives and issues related to the work and grooming best correlate with satisfaction with the specialty.

Conclusions

When the numbers of Finnish postgraduate medical grooming posts go regulated, a renewed focus should be given to finding the most suitable speciality for each doctor. Information near employment and career advice should play an important role in this.

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Background

As the population – and also health care personnel – are ageing, major challenges volition emerge in meeting the demand of equal health care services for the entire population [1–iii]. In Republic of finland it was recently constitute that the problems concerning a sufficient number of medical specialists in the time to come are going to vary greatly in dissimilar medical specialties and also in different regions [iv, 5]. For example, psychiatric disciplines seem to have problems in having enough specialists in the whole Finland while some surgical specialties are at risk of excess of specialists at least in some areas. One of the master reasons for this workforce imbalance is that in Finland, in practice, a doctor has been able to choose the specialty he or she prefers without whatever restrictions.

It has been found that an involvement in people is the nigh important factor when a young student is entering medicine [6, 7]. Furthermore, the content of the piece of work also seems to direct the selection of specialty during studies [8]. Still, the idea of future medical specialty is non stable during undergraduate studies and information technology can be seen equally a process that evolves during medical training [nine–eleven]. Even afterward that, the choice of medical specialty is non e'er stable and the stability of the choice also varies between specialties [12].

The career satisfaction of a doctor is a circuitous question. It may be affected by, for case, workload, workplace stress, system of the work, quality of care and ability to access quality services for patients and fair distribution of rewards [xiii–22]. There are also differences between specialties in the importance of unlike factors explaining job satisfaction [22, 23].

In Finland, lx % of all working-age doctors and 81 % of working-age doctors over 45 years old are medical specialists [24, 25]. Of all specialists, 24 % have two or more specialties (Finnish Medical Clan, unpublished information). Females contain 59 % of all working-age doctors and 57 % of medical specialists [26]. Just i % of immature Finnish doctors do not intend to specialize [27].

Considering of the imbalance of medical specialists noted recently, in that location are now plans to develop a new selection procedure for postgraduate medical grooming so that the imbalance tin can exist corrected [28]. This is a part of other plans stated after a nearly decade-long argue virtually developing postgraduate medical and dental didactics in Republic of finland [28–30].

In this present situation in Republic of finland, it is important to find out how medical graduates can be directed to cull specialties where there is shortage of specialists in a mode that ensures that they are also motivated and volition stay in that particular career path. The aim of this report was to find out what the main reasons are for choosing a medical specialty and whether there are whatever correlations between these motives and dissatisfaction with the chosen specialty.

Methods

The Physician 2013 report was undertaken as a collaborative project of the University of Eastern Finland (formerly University of Kuopio), the University of Tampere and the Finnish Medical Association [31]. It followed previous studies conducted in 1988, 1993, 1998, 2003 and 2008. The study compiled information on social background, piece of work history, labour market and career plans in the medical profession in Republic of finland. It also assessed doctors' views of undergraduate and specialist training, values and professional identity. The questions were mostly formed earlier the first study in 1988, although some new questions have been added in subsequently questionnaires. Most of the questions used in the inquiry have existed in the same grade since the first questionnaire, for reasons of comparability. In the 2013 study, both postal and electronic questionnaires were used. Addresses were collected from the database of the Finnish Medical Association, which has details on all doctors licensed in Republic of finland. The basic study population in the Doc 2013 report was comprised of all Finnish doctors under 70 years of historic period (N = 21,501). A random sample of approximately 50 % was drawn from this basic report population based on the subjects' birthdays then that only those built-in on odd-numbered days were selected for the sample (n = ten,600). The formation of the data is presented in Table 1.

Tabular array ane Forming the data of the Physician 2013 study

Total size table

The response rate of women (53 %) was higher than the response rate of men (46 %). The response rate varied in different historic period groups, existence the lowest in the grouping of 35–44-year-former respondents. Medical specialists (55 %) too answered more than often than unspecialised doctors (43 %). To control possible non-response bias and to improve the representativeness of the results, historic period, gender and specialization status distributions of all Finnish doctors were used to calculate weights to each survey respondent. People in nether-represented groups were given a weight greater than i and those in over-represented groups were given a weight smaller than one, with the weighting being proportionate to the caste of over- or under-representation.. The distributions concerning all Finnish doctors were derived from the register of Finnish Medical Association. For the assay of this study, the working-age medical specialists were selected from the weighted data.

The respondents were asked: "If yous are a specialist or in specialist preparation, to what extent did the following items touch your choice of specialty?" and they were presented with eleven items which could accept influenced their choice. This same question has been asked in the previous studies. The data were classified by means of a Likert 5-point scale. The respondents were too asked: "If you were making the choice over again, would you notwithstanding choose the same medical specialty?"

The respondents were grouped based on gender, historic period, working sector, specialty and academy of specialist preparation. The data were analysed using cross-tabulation and a Chi-squared test to test differences between dissimilar groups of doctors if they would have chosen a different specialty if making the choice again. To summate odds ratios (with 95 % confidence intervals) for the risk of answering "No" to the question "If y'all were making the pick again, would you however cull the same medical specialty?" a binary logistic regression model was besides made with gender, age, items named as important motives for choosing a specialty by more than 25 % of the respondents, correspondence betwixt specialist grooming and electric current work, working sector and specialty as independent variables. Nagelkerke's R-squared and Hosmer-Lewenshow tests were conducted for the logistic regression model. The data were analysed using IBM SPSS 22.0.0.0 for Macintosh predictive analytics software.

Results

The most frequent motive for choosing a specialty was Diversity of work, followed by Good example ready past colleagues in the specialty, Positive experiences in the specialty during undergraduate training and Expert prospects of employment (Fig. 1).

Fig. 1
figure 1

Motives to choose a medial specialty in Physician 2013 Study. Proportions (%) of working-age medical specialists who answered "Considerably" or "Very much" to the question "If you are a specialist or in specialist training, to what extent did the following items impact your choice of specialty?" in Md 2013 report (n = 2796)

Full size epitome

When the answers of male and female person respondents were compared, in that location were some significant differences in the motives for choosing a medical specialty (Fig. ii). Prestigious field, Opportunities for career development, Opportunity to gain a good income, Opportunity to carry out inquiry, Opportunities to work in the private sector and Positive experiences in the specialty during undergraduate training were significantly more than of import motives for male person respondents. On the other hand, Expert opportunity to balance family and work, Reasonable on-call load and Opportunity to control the corporeality of work were more important for female respondents.

Fig. two
figure 2

Differences between male and female doctors when choosing a medical specialty. Differences of proportions (%-units) of working-age male and female medical specialists who answered "Considerably" or "Very much" to the question "If you are a specialist or in specialist training, to what extent did the following items affect your selection of specialty?" in Medico 2013 report. **p <0.01, *p <0.05, males n = 1256 and females north = 1540

Full size image

Of all the respondents, 12 % would not have chosen the same specialty if making the option again (Table 2). In that location was no significant difference between genders. Older doctors would not have called the same specialty more oft compared with younger doctors.

Table ii Proportions of those respondents who would non choose the same medical specialty again

Full size tabular array

The differences betwixt doctors working in unlike working sectors were rather minor, merely statistically pregnant. A smaller proportion of doctors working in specialised medical care answered "No" to the question "If you were making the choice again, would you still cull the same medical specialty?" compared with the doctors in primary health intendance, the individual sector and public institutions.

Nigh one-fifth of specialists in general practice and anaesthesiologists would choose a unlike specialty if making the choice again, while merely fewer than 5 % of paediatricians and a little over 2 % of ophthalmologists were not satisfied with their pick of specialty. There were no statistically significant differences between universities of specialist grooming among those who would non choose the aforementioned specialty again.

In the binary logistic regression model, when odds ratios for the chance of answering "No" to the question "If you were making the choice again, would yous yet choose the same medical specialty?" were calculated, at that place was no statistical deviation betwixt genders. The age groups of 45–54-year-old and 55–64-year-old respondents had a higher odds ratio to respond "No" compared with the under-45-year-old respondents (Tabular array 3).

Table 3 Odds ratios for not choosing the same medical specialty once more

Full size table

When looking at the unlike motives affecting the choice of a medical specialty, the just differences came in Diverseness of work, By chance and Prestigious field. The respondents who felt that Diverseness of work and Prestigious field were of import motives for choosing a specialty had a lower odds ratio to answer "No" to the question "If you were making the choice once again, would yous still choose the same medical specialty?" compared with the respondents who regarded these motives less important. The respondents who felt By chance was an important motive had a higher odds ratio to answer "No" than the others.

The respondents who reported Good correspondence between specialist training and current work had a significantly lower odds ratio to answer "No" to the question "If yous were making the choice once again, would you yet choose the same medical specialty?" compared with the other respondents. Doctors working in primary health care had a significantly lower odds ratio to reply "No" compared with doctors working in specialized medical care and in the private sector.

General practitioners' odds ratio to answer "No" to the question "If y'all were making the choice again, would you withal choose the same medical specialty?" was significantly college compared with internists, ophthalmologists and paediatricians.

Discussion

According to this study, the motive to choose i'south medical specialty that best correlated with satisfaction with the chosen medical specialty was Variety of work. Some other chief finding was that Correspondence between specialist preparation and current work had a pregnant correlation with satisfaction with the specialty. A major office of Risk in selection of the specialty correlated with dissatisfaction with the specialty. Motives of males and females to choose a specialty differed significantly.

Diversity of work was the main motive for choosing a specialty, as it was also in the previous Physician 2008 report [32]. However, medical students' commencement experiences of colleagues and the content of the particular specialty besides seem to accept a major role in option of the specialty [3, 32–36]. It is also noteworthy, although natural, that doctors desire to evaluate possibilities for future employment when choosing a medical specialty.

In this study, 12 % of the respondents would not have called the same medical specialty if making the choice at present. This means that a large majority of the specialists were really quite happy with their choice. Still, fifty-fifty though the proportion of dissatisfied specialists was rather small, it was notable. Also, it has to exist noted that there were some meaning differences betwixt specialties in this matter, revealing that despite the quite skilful overall state of affairs, in that location are some specialties that would need some attention. Specialists in general practice, in particular, had a significant odds ratio to be dissatisfied with their medical specialty compared with another specialties. On the other paw, working in primary health care reduced the odds ratio of dissatisfaction with the specialty. At first glance in that location seems to be a discrepancy in these findings, since when examined independently, respondents working in primary health care were somewhat more dissatisfied with their specialty than those working in specialised medical care. One explanation for this might be that in Finland medical specialists, especially specialists in full general practice, work in many different fields of medicine, and therefore besides satisfaction with the specialty may vary accordingly. For example, approximately thirty % of Finnish specialists in general practice work outside of main health intendance, and approximately 25–30 % of specialists working in primary health care take a specialty other than general practice (Finnish Medical Clan, unpublished information). Therefore, information technology might be that other specialists working in principal health intendance are especially satisfied with their career path. Still, the reasons behind this finding would definitely need some further examination.

For females, motives related to work-family remainder were more important, while male respondents preferred motives related to the external factors of work life, such equally career, professional person appreciation and salary. For females, flexibility and quality of life seem to be important factors when choosing their medical career, fifty-fifty when information technology means compromising professional person achievements [37–41]. On the other hand, differences in controllable lifestyle, on-call work and work-family balance play a more pregnant role than formerly in a young dr.'s career decisions, also among young male doctors [42–44]. However, according to this study, gender or motives related to a controllable lifestyle practise not seem to correlate with satisfaction with the chosen specialty. Still, it is important to take them into consideration when developing the selection process and content of postgraduate medical educational activity for the younger generation of doctors. Notwithstanding, the youngest grouping of respondents seemed to be the near satisfied with their specialty. The reasons for this are not clear. It is possible that members of the younger generation have chosen their career more carefully and truly are more than satisfied with their medical specialty. Only this may as well betoken, for example, that one gets more critical towards ain choices in later stages of 1's career.

Perceived quality of the specialist training programme had a very small-scale part in the choice of medical specialty. Withal, at the same time Correspondence of the specialist grooming to the electric current piece of work significantly predicted satisfaction with the chosen specialty. It seems that medical educators should be able to ameliorate reveal the content of the postgraduate medical grooming likewise as the content of the work as a medical specialist.

The force of this study is that it provides national data on Finnish working-historic period medical specialists. However, in that location are obviously some limitations. First of all, when the first written report in this series was conducted in 1988, there were few other studies addressing this consequence or requirements to validate the questionnaire. Since and then the questionnaires have been largely the same in order to accomplish comparability. With questionnaires of this kind, i needs to admit possible bias stemming from the respondents' self-reporting. In some cases respondents may complete the questionnaire differently when they know the results are going to exist seen. Answering "No" to the question about choosing the same medical specialty now does not bespeak whether the respondent really intends to seek another specialty. No assumptions can therefore exist made in this direction. Instead, our interpretation is that it indicates dissatisfaction with the chosen specialty, and has been used as such in this written report. The terms used in the study were not explained in the questionnaire. Therefore, we cannot be admittedly sure how the respondents understood the pregnant of, for instance, Diversity of work as a reason to choose a specialty. However, this should not have any major impact on the conclusions of this study.

In this written report the respondents had to call up dorsum to the fourth dimension when they were deciding which specialty training plan they would choose and endeavor to recall their reasons at that time. It has been reported that of import life events remain fairly well stock-still in retentivity [45]. Since the selection of professional career tin be considered such an issue, one can assume that items related to it are well recalled.

Conclusions

Equally mentioned earlier, there is an urgent demand in Finland to evaluate and regulate the number of postgraduate trainees in medical specialty training programmes. Nonetheless, the real claiming here is to combine this with the fact that under the electric current situation virtually specialists are actually quite happy with their selection of specialty. To be satisfied with their careers, doctors should keep to be able to find a speciality that they find interesting and that suits their personality and life [46, 47]. At the aforementioned time, the function of hazard should be kept as minimal as possible. To do this, career guidance should have a part during medical school and also after graduation [36]. Medical students and graduates should likewise be kept well informed about the present employment situation in each specialty, so that they tin can take it into consideration and, if necessary, requite thought to some other specialty than their offset option. Too interviews might aid in the choice procedure [48–l]. The importance of first working experiences and the example set by colleagues is something that needs to be looked at closely, especially in specialties that are defective a sufficient workforce. Furthermore, correspondence to the content of the work every bit a medical specialist should be the main target when developing the postgraduate medical training to meet the demands of the 21st century.

Ideals approving and consent to participate

Non applicaple. According to Ideals Commission and based on the Finnish Medical Research Human action and Personal Data Act, studies of this kind do not need ethical approving, since they practice not touch the respondent's personal integrity and as respondents are gratuitous to choose whether to respond or non. Respondents were fully informed nigh the employ of the questionnaires in the cover letters. Because of this it was presumed that respondents gave an informed consent when choosing to answer the questionnaire.

Availability of information and materials

The information of this study is available upon request from the authors.

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Funding

This study has been partly funded by the Finnish Ministry of Social Affairs and Wellness. The funding has been used for costs associated with conveying out the collection of the data. The ministry has non have any role in blueprint, analysis or estimation of this study.

Author information

Writer notes

    Affiliations

    1. Unit of Primary Health Care, Infirmary District of Northern Savo, P.O. Box 1777, FI 70211, Kuopio, Finland

      Teppo J. Heikkilä

    2. Emergency Section, Kuopio University Infirmary, P.O. Box 1777, FI 70211, Kuopio, Finland

      Harri Hyppölä

    3. Finnish Medical Association, P.O. Box 49, FI 00501, Helsinki, Finland

      Jukka Vänskä, Hannu Halila & Santero Kujala

    4. Section of General Do, School of Medicine, University of Tampere, Kalevantie 4, FI 33014, Tampere, Finland

      Irma Virjo, Markku Sumanen & Elise Kosunen

    5. Centre of General Practice, Pirkanmaa Infirmary District, P.O. Box 2000, FI 33521, Tampere, Finland

      Kari Mattila

    Respective author

    Correspondence to Teppo J. Heikkilä.

    Additional information

    Competing interests

    The authors declare that they accept no competing interests.

    Authors' contributions

    TJH has been principally responsible for writing and preparing this paper, and he is the corresponding author. HHy has fabricated a major contribution to the pattern and editing of this paper. JV has significantly contributed to the blueprint and editing of this paper especially in the statistical issues. HHa has played an important office in the design and editing of this newspaper. SK has played an important part in the blueprint and editing of this paper. IV has played an important part in the design and editing of this newspaper. MS has played an important part in the design and editing of this paper. EK has played an of import office in the design and editing of this paper. KM has played an important part in the design and editing of this paper. All authors have read and approved the final manuscript.

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    Teppo J Heikkilä, Dr., works in this study group every bit a researcher in Unit of General Practice in the Infirmary District of Northern Savo. He works also as a senior medical officer in Ministry building of Social Affairs and Health. He is specializing in public health medicine.

    Harri Hyppölä, Doc, PhD, has specialized in public health medicine, internal medicine, and acute medicine. He works every bit a chief md in the Emergency Department of the Kuopio University Hospital. The topic of his thesis in 2001 was undergraduate medical education in Finland. He is besides offshoot professor of wellness care assistants at the University of Tampere.

    Jukka Vänskä has educational background in social sciences (1000.Soc.Sc). He works as enquiry chief at the Finnish Medical Association. Vänskä has published several articles on physicans' education, employment and working conditions.

    Hannu Halila, Medico, PhD, is deputy main executive officeholder at the Finnish Medical Association and a specialist in obstetrics and gynaecology. He is likewise offshoot professor of health care administr ation at the University of Helsinki and by president of UEMS (European Union of Medical Specialists).

    Santero Kujala, Medico, is medical councellor and a former deputy chief executive officer of the Finnish Medical Association. He is a specialist in both occupational health and in general do.

    Irma O. Virjo, Dr., PhD, is specialist in general do and one-time Professor of Full general Practice at the Medical School of the Univeristy of Tampere, retired in 2010. She has for many years been developing medical education on undergraduate and postgraduate level. She has also washed research on medical teaching.

    Markku Sumanen, MD, PhD, is a specialist in full general practise. He works as an Associate Professor of General Practice at the Medical School of the University of Tampere. He has developed medical pedagogy on undergraduate level and has received the special competence in medical didactics.

    Elise Kosunen, Medico, PhD, works every bit a Professor of Full general Practice at the Medical School of the University of Tampere. She has developed medical education on both undergraduate and postgraduate level.

    Former Professor Kari Mattila, Doctor, PhD, is founder member of the projection studying medical profession since the twelvemonth 1988. He is a specialist in full general practice and public health. His special involvement is vocational training in primary health care. He has worked since 1975 as instructor in the universities of Tampere and Turku.

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    Heikkilä, T.J., Hyppölä, H., Vänskä, J. et al. What predicts doctors' satisfaction with their called medical specialty? A Finnish national report. BMC Med Educ 16, 125 (2016). https://doi.org/10.1186/s12909-016-0643-z

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    • DOI : https://doi.org/10.1186/s12909-016-0643-z

    Keywords

    • Primary Health Care
    • Specialist Training
    • Medical Specialty
    • Binary Logistic Regression Model
    • Important Motive

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