Iranian Journal of Medical Sciences

Document Type : Original Article(s)

Authors

1 Department of Health Care Management and Health Economics, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran

2 Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran

3 Health Human Resources Research Center, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/ijms.2021.89938.2071

Abstract

Background: The medical specialty choice of physicians directly affects the healthcare system, community wellbeing, and their own professional life. It is therefore important to identify its underlying factors to predict such medical career choices and to draw up a comprehensive evidence-based public health policy and health human resources planning. The present qualitative study aimed to identify these determinants of career choices through semi-structured interviews with medical doctors in the context of country-specific social and cultural characteristics.
Methods: The present qualitative study was carried out in 2019-2020 at Shiraz University of Medical Sciences (Shiraz, Iran). The target population was medical students, junior doctors, and medical residents. The purposive sampling method was used to recruit the participants and sampling continued until data saturation, i.e., no new information could be extracted. Data were collected through individual, face-to-face, semi-structured interviews and analyzed using the conventional content analysis method. Inductive thematic analysis was used to interpret the data based on which a thematic map was developed illustrating the factors influencing medical specialty preferences in Iran. Data trustworthiness was assessed according to the criteria proposed by Guba and Lincoln.
Results: Analysis of the interview data resulted in three main themes and fourteen sub-themes. The main themes were “Personal determinants”, “Career-related factors”, and “Interpersonal influences”. The most important sub-themes were personal interests, income, and prestige.
Conclusion: The determinants influencing the specialty preferences of Iranian medical doctors are identified. Our findings will facilitate the development of a comprehensive evidence-based public health policy, health human resources planning, and appropriate medical education policy.

Keywords

  1. Kaliyadan F, Amin TT, Qureshi H, Al Wadani F. Specialty preferences of 1(st) year medical students in a Saudi Medical School - Factors affecting these choices and the influence of gender. Avicenna J Med. 2015;5:134-9. doi: 10.4103/2231-0770.165120. PubMed PMID: 26629470; PubMed Central PMCID: PMCPMC4637952.
  2. Querido S, van den Broek S, de Rond M, Wigersma L, Ten Cate O. Factors affecting senior medical students’ career choice. Int J Med Educ. 2018;9:332-9. doi: 10.5116/ijme.5c14.de75. PubMed PMID: 30594907; PubMed Central PMCID: PMCPMC6387763.
  3. Cleland J, Johnston PW, French FH, Needham G. Associations between medical school and career preferences in Year 1 medical students in Scotland. Med Educ. 2012;46:473-84. doi: 10.1111/j.1365-2923.2012.04218.x. PubMed PMID: 22515755.
  4. Pfarrwaller E, Sommer J, Chung C, Maisonneuve H, Nendaz M, Junod Perron N, et al. Impact of Interventions to Increase the Proportion of Medical Students Choosing a Primary Care Career: A Systematic Review. J Gen Intern Med. 2015;30:1349-58. doi: 10.1007/s11606-015-3372-9. PubMed PMID: 26173529; PubMed Central PMCID: PMCPMC4539313.
  5. Sivey P, Scott A, Witt J, Joyce C, Humphreys J. Junior doctors’ preferences for specialty choice. J Health Econ. 2012;31:813-23. doi: 10.1016/j.jhealeco.2012.07.001. PubMed PMID: 22940638.
  6. Takeda Y, Morio K, Snell L, Otaki J, Takahashi M, Kai I. Characteristic profiles among students and junior doctors with specific career preferences. BMC Med Educ. 2013;13:125. doi: 10.1186/1472-6920-13-125. PubMed PMID: 24028298; PubMed Central PMCID: PMCPMC3847686.
  7. Al-Shamsi M. Addressing the physicians’ shortage in developing countries by accelerating and reforming the medical education: Is it possible? J Adv Med Educ Prof. 2017;5:210-9. PubMed PMID: 28979916; PubMed Central PMCID: PMCPMC5611431.
  8. Kwon OY, Park SY. Specialty choice preference of medical students according to personality traits by Five-Factor Model. Korean J Med Educ. 2016;28:95-102. doi: 10.3946/kjme.2016.14. PubMed PMID: 26838573; PubMed Central PMCID: PMCPMC4926941.
  9. Mullola S, Hakulinen C, Presseau J, Gimeno Ruiz de Porras D, Jokela M, Hintsa T, et al. Personality traits and career choices among physicians in Finland: employment sector, clinical patient contact, specialty and change of specialty. BMC Med Educ. 2018;18:52. doi: 10.1186/s12909-018-1155-9. PubMed PMID: 29587722; PubMed Central PMCID: PMCPMC5870817.
  10. Alawad AA, Khan WS, Abdelrazig YM, Elzain YI, Khalil HO, Ahmed OB, et al. Factors considered by undergraduate medical students when selecting specialty of their future careers. Pan Afr Med J. 2015;20:102. doi: 10.11604/pamj.2015.20.102.4715. PubMed PMID: 26090050; PubMed Central PMCID: PMCPMC4458322.
  11. Dehn P, Eika B. Who’s choosing whom? A sociological study of the specialty choices in a Danish context. International Journal of Medical Education. 2011;2:36-43. doi: 10.5116/ijme.4dad.c33f. PubMed PMID: PMC4205518.
  12. Al-Fouzan R, Al-Ajlan S, Marwan Y, Al-Saleh M. Factors affecting future specialty choice among medical students in Kuwait. Med Educ Online. 2012;17:19587. doi: 10.3402/meo.v17i0.19587. PubMed PMID: 28165921.
  13. Correia Lima de Souza L, Mendonca VR, Garcia GB, Brandao EC, Barral-Netto M. Medical Specialty Choice and Related Factors of Brazilian Medical Students and Recent Doctors. PLoS One. 2015;10:e0133585. doi: 10.1371/journal.pone.0133585. PubMed PMID: 26208007; PubMed Central PMCID: PMCPMC4514603.
  14. Al-Ansari SS, Khafagy MA. Factors affecting the choice of health specialty by medical graduates. J Family Community Med. 2006;13:119-23. PubMed PMID: 23012131; PubMed Central PMCID: PMCPMC3410059.
  15. Abdulrahman M, Makki M, Shaaban S, Al Shamsi M, Venkatramana M, Sulaiman N, et al. Specialty preferences and motivating factors: A national survey on medical students from five uae medical schools. Educ Health (Abingdon). 2016;29:231-43. doi: 10.4103/1357-6283.204225. PubMed PMID: 28406108.
  16. Alef-News-Group [Internet]. Statistics of the number of general practitioners, specialists and specialists in the country. Iran: ALef News Group. c2019 [Cited 2 September 2020]. Available from: https://www.alef.ir/news/3980515114.html. Persian.
  17. The World Bank Data [Internet]. Physicians (per 1,000 people) - Iran, Islamic Rep. [Cited 11 March 2021]. Available from: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=IR
  18. Bayat M, Shokri A, Mirbahaeddin E, Khalilnezhjad R, Khatibi SR, Fattahi H, et al. Geographic Distribution of Active Medical Specialists in Iran: A Three-Source Capture-Recapture Analysis. Arch Iran Med. 2020;23:15-22. PubMed PMID: 31910630.
  19. Queirós A, Faria D, Almeida F. Strengths and limitations of qualitative and quantitative research methods. European journal of education studies. 2017;3:369-87. doi: 10.46827/ejes.v0i0.1017.
  20. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24:105-12. doi: 10.1016/j.nedt.2003.10.001. PubMed PMID: 14769454.
  21. Wainwright D, Harris M, Wainwright E. How does ‘banter’ influence trainee doctors’ choice of career? A qualitative study. BMC Med Educ. 2019;19:104. doi: 10.1186/s12909-019-1531-0. PubMed PMID: 30975136; PubMed Central PMCID: PMCPMC6460642.
  22. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277-88. doi: 10.1177/1049732305276687. PubMed PMID: 16204405.
  23. Guba EG, Lincoln YS. Competing paradigms in qualitative research. Handbook of qualitative research. 1994;2:105.
  24. Alshahrani M, Dhafery B, Al Mulhim M, Alkhadra F, Al Bagshi D, Bukhamsin N. Factors influencing Saudi medical students and interns’ choice of future specialty: a self-administered questionnaire. Adv Med Educ Pract. 2014;5:397-402. doi: 10.2147/AMEP.S69152. PubMed PMID: 25368542; PubMed Central PMCID: PMCPMC4216024.
  25. Anand R, Sankaran PS. Factors influencing the career preferences of medical students and interns: a cross-sectional, questionnaire-based survey from India. J Educ Eval Health Prof. 2019;16:12. doi: 10.3352/jeehp.2019.16.12. PubMed PMID: 31117329; PubMed Central PMCID: PMCPMC6609296.
  26. Guraya SY, Almaramhy HH. Mapping the factors that influence the career specialty preferences by the undergraduate medical students. Saudi J Biol Sci. 2018;25:1096-101. doi: 10.1016/j.sjbs.2017.03.019. PubMed PMID: 30174508; PubMed Central PMCID: PMCPMC6117166.
  27. Gutierrez-Cirlos C, Naveja JJ, Garcia-Minjares M, Martinez-Gonzalez A, Sanchez-Mendiola M. Specialty choice determinants among Mexican medical students: a cross-sectional study. BMC Med Educ. 2019;19:420. doi: 10.1186/s12909-019-1830-5. PubMed PMID: 31727026; PubMed Central PMCID: PMCPMC6854711.
  28. Kristoffersson E, Diderichsen S, Verdonk P, Lagro-Janssen T, Hamberg K, Andersson J. To select or be selected - gendered experiences in clinical training affect medical students’ specialty preferences. BMC Med Educ. 2018;18:268. doi: 10.1186/s12909-018-1361-5. PubMed PMID: 30453953; PubMed Central PMCID: PMCPMC6245780.
  29. Alsubaie N, Aldhofaian HS, Alhuwaimel L, Ruxshan N, Alghamdi F, Shamia A, et al. Specialty Preferences and the Factors Influencing Them Among Pre-Clerkship Medical Students: The First Study from Alfaisal University-College of Medicine, Saudi Arabia. Cureus. 2016;8:e894. doi: 10.7759/cureus.894. PubMed PMID: 28018764; PubMed Central PMCID: PMCPMC5179192.
  30. Sheikh A, Naqvi SH, Sheikh K, Naqvi SH, Bandukda MY. Physician migration at its roots: a study on the factors contributing towards a career choice abroad among students at a medical school in Pakistan. Global Health. 2012;8:43. doi: 10.1186/1744-8603-8-43. PubMed PMID: 23241435; PubMed Central PMCID: PMCPMC3542032.
  31. Asongu SA. The impact of health worker migration on development dynamics: evidence of wealth effects from Africa. Eur J Health Econ. 2014;15:187-201. doi: 10.1007/s10198-013-0465-4. PubMed PMID: 23460479.
  32. Rehman A, Rehman T, Shaikh MA, Yasmin H, Asif A, Kafil H. Pakistani medical students’ specialty preference and the influencing factors. J Pak Med Assoc. 2011;61:713-8. PubMed PMID: 22204259.
  33. Adnan S, Khaliq H, Irfan M. A cross sectional study on the choices of female medical students in selection of their future specialties. Journal of Postgraduate Medical Institute. 2016;30:230-4.
  34. Wang KI, Chang PY, Hung CY, Huang YH. Analysis of senior medical students’ preferences in specialty choice a survey in a medical school in northern Taiwan. Chang Gung Med J. 2007;30:339-53. PubMed PMID: 17939264.
  35. Koinis A, Giannou V, Drantaki V, Angelaina S, Stratou E, Saridi M. The Impact of Healthcare Workers Job Environment on Their Mental-emotional Health. Coping Strategies: The Case of a Local General Hospital. Health Psychol Res. 2015;3:1984. doi: 10.4081/hpr.2015.1984. PubMed PMID: 26973958; PubMed Central PMCID: PMCPMC4768542.
  36. Hamid S, Ali Inam SH, Jamil H, Zeb R. Speciality preference with respect to gender among medical students of Pakistan. J Pak Med Assoc. 2019;69:1190-3. PubMed PMID: 31431778.
  37. Sievert M, Zwir I, Cloninger KM, Lester N, Rozsa S, Cloninger CR. The influence of temperament and character profiles on specialty choice and well-being in medical residents. PeerJ. 2016;4:e2319. doi: 10.7717/peerj.2319. PubMed PMID: 27651982; PubMed Central PMCID: PMCPMC5018665.
  38. Onyemaechi N, Bisi-Onyemaechi AI, Omoke NI, Odetunde OI, Okwesili IC, Okwara BO. Specialty choices: Patterns and determinants among medical undergraduates in Enugu Southeast Nigeria. Niger J Clin Pract. 2017;20:1474-80. doi: 10.4103/njcp.njcp_382_16. PubMed PMID: 29303135.
  39. Khader Y, Al-Zoubi D, Amarin Z, Alkafagei A, Khasawneh M, Burgan S, et al. Factors affecting medical students in formulating their specialty preferences in Jordan. BMC Med Educ. 2008;8:32. doi: 10.1186/1472-6920-8-32. PubMed PMID: 18501004; PubMed Central PMCID: PMCPMC2423351.
  40. Ali A, Rasheed A, Hussaiin Zaidi SM, Ashraf Jahangeer Alsaani SM, Naim H, Hamid H, et al. Recent Trend in Specialty Choices of Medical Students and House Officers from Public Sector Medical Universities, Karachi. J Pak Med Assoc. 2019;69:489-94. PubMed PMID: 31000850.