630
11 SEPTEMBER 1976
JOURNAL BRITISH MEDICAL JOURNAL
BRITISH MEDICAL
630
11 SEPTEMBER 1976
Contemporary Themes
Career preferences of doctors graduating in 1974 J
PARKHOUSE, C McLAUGHLIN
British Medical journal, 1976, 2, 630-632
Summary Questionnaires were sent to all 2348 doctors who had graduated from medical schools in England, Scotland, and Wales in 1974 asking about their career preferences. Most were in their second preregistration post, and the response rate was 861%. The most popular first choice of career was general practice (665 of the responders; 32-90,), followed by medicine (454; 22 50O), surgery (321; 15.90'o), and paediatrics (129; 644%). Only 507 of the responders (25 1 ), however, stated that their preference was "definite." First choices differed widely between men and women graduates and between graduates of different medical schools. o
TABLE I-Response rates of graduates of various medical schools and proportions of responders known to be women
Results Out of 2348 graduates contacted 2022 (86-1 %) replied. The response medical schools (table I), being 900o or above for five schools and below 80% for four. The lowest response rate was 73%. Some responders failed to answer all the questions. rates varied between
DETAILS OF RESPONDERS
Sex,
age,
Response O0 of rate responders known to (0") be women
Medical school
be women
Aberdeen Birmingham Bristol Dundee Edinburgh Glasgow Leeds Liverpool Manchester Newcastle Oxford Sheffield Wales
TABLE
Introduction In view of the high response rates and interest shown in previous inquiriesl-3 into career preferences of graduates of the Manchester and Sheffield medical schools we decided to survey all doctors who had graduated from the medical schools of England, Scotland, and Wales in 1974. This was done during the spring and early summer of 1975, when most were in their second preregistration post. Names and addresses were obtained from the deans of the medical schools, and each graduate was sent a questionnaire. Two reminders were sent to nonresponders, and the last replies were received during September 1975.
0O of [Response rate responders (% known to "')
Medical school
44 29 37 31 26
89 87 90 94 90 88 91 79 86 89 76 91 87
26 30 29 30 30 12 33 30
Charing Cross Guy's King's College The London The Middlesex Royal Free St Bartholomew's St George's St Mary's St Thomas's University College Westminster
29 15 25 19 15 47 13 21 31 21 32 15
85 74 85 89 88 89 86 73 89 84 85 87
II-Age and marital state of responders
Age (years) Unknown 22 23 24 25 26 27 28 29 30 Over 30
Married
Single
Unknown
14
27 6 104 384 316 100 29 18 6 6 20
22
1 77 268 295 91 37 23 11 10 28 855 (42 3%)
Total
1 13 38 44 15 8 4 2 1 3 151 (750%)
1016 (50 3 0))
Total 63 (3-1 00) 8 (040.,) 194 (9-6,O) 690 (34-1 0 ) 655 (32 4"/ ) 206 (10-2 0,) 74 (3.70,) 45 (2-2 °b) 19 (0 9 h0) 17 (0-8 0) 51 (2-5 0) 2022 (100°')
Country of birth and nationality-Table III shows the countries of birth of the responders. Altogether 1924 (95.2%) were British, 71 (3-50o) were of other nationalities, and 27 (1-3%) did not give their nationality. It is important to distinguish between nationality and country of birth, since data from the University Grants Committee are calculated from figures for "home-based" students, whereas the DHSS tables are based on "British-born" doctors. If allowance is made for those responders whose nationality and place of birth were not given it appears that in 1974 there were between 100 and 200 graduates of British nationality who were not born in the United Kingdom.
and marital state-Altogether 1442 of the responders
(71-3%) were men and 548 (27-1%) women, the sex of the remaining 32 (1-6%) being unknown. The ratios of men to women varied considerably between medical schools (table I). Table II shows the marital state of the responders in relation to their age; 855 (42-3%) were known to be married.
TABLE iii-Countries of birth of responders Country of birth
England
University Hospital of South Manchester, Manchester M20 8LR J PARKHOUSE, MA, MD, professor of anaesthetics Polytechnic of the South Bank, London SEl OAA C McLAUGHLIN, MSc, lecturer in quantitative analysis
No 1110
Wales .88 Scotland Northern Ireland UK (not-specified) Eire .3 Other (non-UK) Unknown .100
Total
0
54-9
256 16 253
4-4 12-7 0-8 12-5
196
9-7 4-9
2022
100-0
0-1
BRITISH MEDICAL JOURNAL
631
11 SEPTEMBER 1976
TABLE v-Proportions of responders giving individual medical and surgical specialties as first choice of career (including tied first and second, and tied first, second, and third choices)*
FIRMNESS OF CAREER CHOICE
In response to the question "Have you made up your mind about your future career ?" 507 of the responders (25 1%) answered "definitely," 1036 (51 20o) "probably," and 472 (23-3%) "not really." As with our previous surveys, the relatively low proportion of graduates having made a definite career decision should be born in mind in interpreting the results.
Medical specialties
PRACTICE IN UNITED KINGDOM
The responders were asked whether they intended to practise permanently in the United Kingdom-that is, discounting any periods that might be spent abroad before finally settling in this country. Altogether 647 (32 00) claimed that they definitely intended to practise in the United Kingdom, only 50 (2-50,') said "definitely not," 1009 (4999%) said "probably yes," and 152 (7-5%) said "probably no." A further 155 (7-70o) were undecided.
Total
Table IV shows the first, second, and third choices of career for all responders. The "mainstream" classification of the Todd Report4 was used, with the addition of paediatrics as a separate specialty from medicine. Table V shows the proportions of responders who gave various medical and surgical subspecialties as their first choice of career. In addition to the responders shown in table V there were 30 who gave a medical or surgical specialty as a tied first choice with
0
305 11
61-6
2-2
12 2 0 10 1 11
2-4 0-4
3 2 13
0-6 0-4 2-6 0-2 1-6
8
2-0 0-2 2-2
16
3-2
100
20-2
495
100
182 6 3 7
12 34 5 4 8 1
surgery
Urology Other (specified) Specialty not specified Acaden-mic surgery 2 or 3 surgical options equal Option tied with nonsurgery choice Total
12 6
24
59.9 2-0 1-0 2-3 3.9 11-2 1-6 1-3
2-6 0-3
3.9
2-0
7.9
0
1..i 304
100
something other than medicine or surgery; in 19 of these cases the medical or surgical choice in question was general surgery. Altogether 29 of the responders gave as their first choice general practice combined with some other form of work (table IV). The most popular combinations were general practice with anaesthetics and with general medicine, which occurred seven and six times respectively. It was, perhaps, surprising that so few responders showed an interest in a combined career of this kind. Table VI shows the relationship between the sex of the responders and their first choice of career. The proportions of women varied greatly with the career option, from 6 8%' for surgery to 66-7% for community medicine. Table VII shows the distribution of career choices for individual medical schools. Here also there are striking differences. For example, the proportions of graduates giving medicine as a first choice varied from 41 30° to 9o8%, and the proportions choosing anaesthetics and pathology ranged from 13-60, to nil and 9-70 to nil respectively. Preferences for general practice ranged from 47-1% to 19-5%.
TABLE iv-Proportions of responders giving various specialties as first, second, and third choices of career First choice No
Second choice
Third choice No
.
0
No
.. ..
454 321
22-5
15-9
394 214
19-5 10-6
141 85
7-0 4-2
.. gynaecology .. General practice General practice with other specialty .. .. Psychiatry .. Community medicine .. .. Pathology .. Anaesthetics .. .. Radiology .. Other (medical) Paediatrics .. Other (non-medical) Not indicated .
78 665
3-9 32-9
116 377
5-7 18-6
72 324
3-6 16-0
29 74 10 53 86 32 64 129 8 19
1-4 3-7 0-5 2-6 4-3 1-6 3-2 6-4 0-4 09
9 73 55 59 86 42 88 147 8 354
0-4
9 52 55 42 62 47 73 82 9 969
0-4 2-6 2-7 2-1 3-1
.. Medicine -Surgery Obstetrics and
No
General surgery (including "surgery") Accident and emergency Ear, nose, and throat Neurosurgery Ophthalmology Orthopaedics .. Paediatric surgery Plastic surgery Thoracic/cardiac
*Medicine and surgery tied as equal first choices in 18 cases.
CHOICE OF CAREER
Specialty
Surgical specialties
No -
General medicine (including "medicine") Cardiology Dermatology Endocrinology Geriatrics Clinical haematology Nephrology Neurology Respiratory/chest medicine Rheumatology Other (specified) Specialty not specified Academic medicine .. 2 or 3 medical options equal Option tied with nonmedicine choice
0
3-6
2-7 2-9 4-3 2-1 4-4 7-3 0-4 17-5
2-3
CHANCES OF SUCCESS
3-6 4-1 0-4 47-9
The responders were asked to assess their chances of success in their chosen careers. The question was clearly open to varying interpretation according to what was meant by success. Overall, 25-1%
TABLE vII-First choices of career selected by responders from each medical school. Figures are percentages of responders 0
u
z
co
._
>1
a>-6
r.
to Aberdeen Birmingham Bristol Dundee Edinburgh Glajgow Leeds Liverpool Manchester Newcastle Oxford Sheffield Wales
. . .. . .. .. ..
.. .. .
.. Charing Cross . Guy's King's College
The London The Middlesex Royal Free . . St Bartholomew's St George's St Mary's St Thomas's
University College
Westminster
Total
1
9-8 12-1 10-3 12-9 21-5 26-2 16-4 14-0 16-3 21-4 34-1 19-4 41-3 20-6 25-6 24-6 22-0 19-4 25-3 36-6 37-2 31-0 27-9 25-3 27-1
9-8 16-8 7-7 22-6 13-8 23-2 11-9 14-0 14-0 14-3 24-4
22-5
44
"
Oo St
cs
ci
ci 1.
a.'.
3-7 0 5-1 4-8 6-2 3-0 3-0 7-5 2-3 1-4 2-4 8-3 3-8
42-7 36-4 47-1 24-2
2-4 1-8 1-3 0 0-8 2-4 3-0 1-1 0-8 0 2-4 0 2-6
30-8
27-4 44-8 32-3 39-5 41-4 19-5
6-1 6-5 1-3 8-1 6-4 3-0
1-0
11-9
2-8 3-8 5-6 7-0 0 4-4 5-5 1-7
34-7 40-5 21-1 20-9 39-4 33-4 28-6 25-4
1-4 5-2 0 0 0 1-5 2-2 0
1-3 0 4-7 2-8 0 2-2 3-4
159
39
T 329
1-4
37
13-9
11-4
19-7 16-3 15-5 17-6
9-9
4-7 5-8
30-6 22-5 38-2
1
0
4-9 0 3-8 9-7 3-8 1-2 1-5 2-2 0-8 5-7 4-9 0 1-3 2-9 2-3 2-9 3-0 4-2 2-6 1-4 4-7 1-4 1-5 3-3 1-7
0-5
2-6
0 0
2-6 3-2 0
1-8
1-5
27-9 29-0 35-0
5-9
0
0
1-1 0 0
0 0 0
0 0 0 0
6-9
1-4 0
1-4 0 0 0 0
T
.0
._
-a
._
a
04
2-9 2-3 0 1-0
22-0
r.oa
aD O
4-3 5-4 2-9 4-9 5-6 1-3 0 4-7 4-3 2-0
19-4 15-0 14-7 23-3 10-1
o
az
u)
.0 0 to
c4 ._
Cc 0
co
7-3 5-6 10-3 3-2 6-9 3-0 7-5 4-3 4-7 4-3 2-4 5-6 1-3 0 1-2 13-0 0 2-8 1-3 1-4 2-3 1-4 2-9 0
13-6 43
z 7-3 7-5 5-1 1-6 6-4 4-2 6-0 11-8
1-2 0-9 2-6 1-6 1-5 1-2 0 3-2 2-3 0 0 1-4 1-3 0 2-3 0 1-0 4-2 0 1-4 4-7 1-4 2-9 1-1
9-3 5-7 0 5-6 8-8 5-9 3-5 7-2 8-0 5-6 5-1 7-0 0 5-6 4-4
3-4 1-6
[
0
4-9 10-3 2-6 3-2 1-5 3-0 1-5 1-1 1-6 1-4 4-9 4-2 1-3 8-8
14-3 5-1
1-2 2-9 3-0 2-8 3-8 2-8 2-3 0 2-9 7-7 1-7
6-4
3-2
0-9 1-6 1-5
'O
0 0 0 0 0 0 0 0 0 1-2 0 1-0 0 0 0 0 1-4 0 0 1-7
1
0-4
632
BRITISH MEDICAL JOURNAL
TABLE vI-Sex distribution of responders giving various specialties as first choice of career
First choice of career
Men
.347 Medicine .. 290 Surgery Obstetrics and gynaecology 56 General practice 433 General practice with other .20 specialty Psychiatry 49 3 Community medicine 27 Pathology .. 62 Anaesthetics Radiology 20 ..47 Other (medical) .68 Paediatrics 4 Other (non-medical) . Not indicated . 16
Total
1442
Women
%
women
Sex not stated
(of responders of known sex)
9 10
22-0 6-8 28-2 34-3
98 21 22 226
6
9 24 6 24 24 11 17 59 4 3
1 1 2
1 2
548
32
31-0 32 9 66-7 47-1 27 9 35-5 26-6 46-5 50-0 15-8 27-5
TABLE VIII-Percentages of responders estimating various chances of success in different specialties
Medicine. . . Paediatrics .. . Surgery Obstetrics and gynaecology General practice Psychiatry Community medicine
Pathology Anaesthetics Radiology and radiotherapy
Total number 75 %