Timing and Predictors of Subspecialty Career Choice Among Internal Medicine Residents: A Retrospective Cohort Study

Abstract

Background Internal medicine residents face numerous career options after residency training. Little is known about when residents make their final career choice. Objective We assessed the timing and predictive factors of final career choices among internal medicine residents at graduation, including demographics, pre-residency career preferences, and rotation scheduling. Methods We conducted a retrospective study of graduates of an academic internal medicine residency program from 2014 to 2017. Main measures included demographics, rotation schedules, and self-reported career choices for residents at 5 time points: recruitment day, immediately after Match Day, end of postgraduate year 1 (PGY-1), end of PGY-2, and at graduation. Results Of the 138 residents eligible for the study, 5 were excluded based on participation in a fast-track program for an Accreditation Council for Graduate Medical Education subspecialty fellowship. Among the remaining 133 residents, 48 (36%) pursued general internal medicine fields and 78 (59%) pursued fellowship training. Career choices from recruitment day, Match Day, and PGY-1 were only weakly predictive of the career choice. Many choices demonstrated low concordance throughout training, and general medicine fields (primary care, hospital medicine) were frequently not decided until after PGY-2. Early clinical exposure to subspecialty rotations did not predict final career choice. Conclusions Early career choices before and during residency training may have low predictability toward final career choices upon graduation in internal medicine. These choices may continue to have low predictability beyond PGY-2 for many specialties. Early clinical exposure may not predict final career choice for subspecialties.

Fatores associados à escolha da segunda especialidade entre concluintes da residência em clínica médica

“…A Tabela 3 mostra, em ordem decrescente das médias na escala de Likert, os fatores mais importantes para a escolha da segunda especialidade após a conclusão do PRM-CM e seus respectivos intervalos de confiança, além do percentual de respostas transformadas em "influência positiva", ou seja, às quais foram atribuídas as pontuações de 4 ou 5 na escala de Likert, representando, respectivamente, "concordo parcialmente" ou "concordo totalmente". Igualmente, outro estudo estadunidense revelou que 59% dos concluintes têm planos de realizar uma segunda especialidade 5 .…”

“…Na literatura internacional, encontram-se alguns trabalhos que discutem os motivos para o clínico optar por se subespecializar. Com base nesses motivos, é possível afirmar que existe cada vez mais tendência desses profissionais à segunda especialização 4,5 , destacando-se como fatores importantes estilo de vida mais controlável e experiências na residência 6 , e a intenção de acompanhamento dos pacientes em longo prazo e o maior retorno financeiro 4,7 .…”

“…Outro dado encontrado em nosso estudo refere-se ao fato de a minoria ter filhos, o que pode corroborar a premissa de que uma população mais jovem opta pela especialização médica. A escolha decisiva da especialidade em nosso estudo ocorreu, na maioria das vezes, no segundo ano de residência, estando de acordo com outros estudos 5 , porém um número significativo de participantes relatou ter escolhido a especialidade já na graduação.…”

Factors associated with the choice of a second specialty among internal medicine residency graduates

“…This number is higher than that found in a study carried out in the United States, which showed that 64.2% of residents in the third year of Internal Medicine intended to work in subspecialties 4 . Additionally, another study carried out in the United States showed that 59% of the graduates had plans to undertake a second specialty 5 . Therefore, the results found among medical students from public universities 13 , which may explain a better performance in the selection processes for Medical Residency; moreover, there has been an increase in the offer of student funding in Brazilian private medical schools 14 in the last decade, and evidence points to a greater tendency to pursue a career as a general practitioner among those with greater debts related to education 7 .…”

“…Some studies in the international literature have discussed the reasons for the clinician to choose to subspecialize. Based on these, it is possible to state that there is an increasing trend among these professionals to undertake a second specialization [4][5] , standing out as important factors a more controllable lifestyle and experiences in the residency period 6 , as well as the intention of monitoring patients in the long term and greater financial return 4,7 .…”