OBJECTIVE. Little is known regarding at what point during the training period residents in pediatrics make decisions on their future career choices. As part of a dedicated process of reexamining the structure of residency training in pediatrics, the American Board of Pediatrics sought information to better understand the influences, process, and sequencing of both residency program selection and career decision-making among residents.METHODS. All pediatrics resident physicians in all training programs in the United States and Canada (N ϭ 8290) received the survey as part of the general pediatrics in-training examination. The survey focused on exploring how and when pediatrics residents make career choices and assessed perceived flexibility of their individual pediatrics residency program.RESULTS. The response rate was 95%. Location was the most important factor in selecting a residency program for 42% of all residents. Almost half of the pediatrics residents planned to pursue fellowship training after residency, a proportion that changed little across the 3 training years (level 1: 47%; level 2: 49%; level 3: 47%). Those who planned to pursue a general pediatrics career (either with or without inpatient care) were more likely than those who intended to pursue fellowship training to report that lifestyle was the most important factor in their career choice (63% vs 21%).CONCLUSIONS. Not surprisingly, different priorities motivate pediatricians to pursue specific programs for training and specific career options. The finding that those with the highest priority regarding lifestyle are more likely to pursue generalist training has implications for the generalist workforce, because those persons may also be more likely to seek part-time employment. Lifestyle concerns may need to be addressed in subspecialty training and subsequent subspecialty careers to ensure a continued flow of residents into fellowship training. Pediatrics 2009;123:S26-S30 T HE DECISION-MAKING PROCESS of residents regarding their future career paths is believed to be associated with a variety of factors. Little is known regarding at what point during the training period residents in pediatrics make decisions on their future career choices. Previous studies have attempted to examine potential predictors during medical school through residency. [1][2][3] It is likely that there are particular subgroups of residents for whom specific influences and experiences have greater influence than others.It is also unknown whether residents choose specific training programs because of their perceived flexibility, whether they desire additional flexibility in their training experiences, and whether such flexibility would have an affect on career choice and the decision to pursue subspecialty fellowship training.Residency training, with respect to duty hours, has changed considerably with the advent of the 80-hour workweek requirements. However, the fundamental structure of pediatrics programs, their mix of inpatient and outpatient care, and their degre...