1 UK Medical Careers Research Group, Department of Public Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK. 2 Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
* Corresponding author. E-mail: michael.goldacre{at}dphpc.ox.ac.uk
Accepted for publication May 12, 2005.
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Abstract |
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Methods. Postal questionnaire surveys were undertaken of qualifiers from all UK medical schools in nine qualification years since 1974.
Results. 74% (24623/33417) and 73% (20709/28468) of doctors responded at 1 and 3 yr after qualification. At 1 and 3 yr after qualification, on average, 8% of doctors chose anaesthesia. Between 1974 and 2002 the percentage of doctors choosing anaesthesia, 1 yr after qualification, increased from 5 to 12%. A majority of doctors who chose anaesthesia 1 and 3 yr after qualification were working in anaesthesia 10 yr after qualification. In addition to doctors' enthusiasm for the specialty, career choices for anaesthesia were positively influenced by their perception of working hours, conditions of work, and career and promotion prospects.
Conclusions. Anaesthesia has become increasingly popular as a career choice in the UK. Training numbers could be increased in the short term to speed up the process of providing a consultant-delivered service.
Keywords: anaesthesia ; anaesthetists, workforce ; education, medical ; junior doctors, career choice
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Introduction |
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Methods |
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The doctors mailed in the first survey of each cohort comprised the whole cohort as it was at the time of qualification. Subsequent surveys of a cohort exclude only those doctors who previously had indicated that they did not wish to participate, or who were untraceable, or who were known to have died. For the initial survey, addresses were obtained from the doctors' registration with the General Medical Council. For follow-up surveys, we used the addresses supplied by the doctors at each previous survey and/or those identified from the most recent Medical Registers and Medical Directories.
One of the key questions asked is Have you made up your mind about your choice of long-term career? We ask the doctors to choose a response from definitely, probably, or not really. We then invite them to specify their choice in their own words and to be as general or specific as they wish. If they have more than one choice, we ask them to list up to three in order of preference and, if applicable, to indicate that choices are of equal preference. Additionally, we invited those graduating in 1993 and 1996 to signify which factors, from a list of 11 possible factors specified in the questionnaire, had influenced their choice of career a great deal, a little, or not at all.
Before 1993, the few early career choices specified as terminal care or palliative care were coded by us as anaesthesia. From 1993 onwards, career choices specified by graduates as terminal care or palliative care have been allocated by us to a separate specialty grouping of palliative care and are not included in this paper.
Statistical analysis
We used 2 statistics for assessing the statistical significance of percentage differences, and logistic regression to compare the percentages of graduates from each medical school who chose anaesthesia, adjusting for sex and year of qualification. We calculated adjusted odds ratios with 95% confidence intervals (CI) to compare choices for anaesthesia at each medical school with the overall average.
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Results |
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Early career choices for anaesthesia
In the first year after qualification, across all cohorts 7.4% of men, 8.0% of women, and 7.7% of respondents signified that anaesthesia was their first choice of long-term career (Table 1). The percentages of men and women choosing anaesthesia were not significantly different (, P>0.05). At the end of the third year after qualification, anaesthesia was the first choice of 8.9% of men, 7.2% of women, and 8.1% overall. The higher percentage of men than women who chose anaesthesia is statistically significant (
, P<0.001). In year one, anaesthesia was chosen as a first, second, or third choice by 13.9% of doctors overall, and by 14.0% of men and 13.7% of women (
, P>0.05). In year three, anaesthesia was chosen by 10.9% of doctors overall, and by 12.1% of men and 9.4% of women (
, P<0.001; Table 2). The percentage of respondents whose first choice was anaesthesia increased in more recent cohorts in both the first and third year after qualification (Table 1). With the exception of women's choices in year three, the upward linear trend in the choice of anaesthesia was statistically significant (Table 1).
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Choices by medical school
There were significant differences between medical schools in the percentages of graduates who chose anaesthesia. Choices in year one (Fig. 1A) for anaesthesia were significantly high for graduates from Bristol (10.5%), Edinburgh (10.3%), Southampton (10.4%), Queen Mary and Westfield (9.2%), and Imperial College (8.5%) and low for graduates from University College London (5.5%), Cambridge (4.7%), and Liverpool (4.7%). Choices in year three (Fig. 1B) were significantly high for graduates from Bristol (10.7%), Aberdeen (10.6%), and Queen Mary and Westfield (10.5%) and low for those from Oxford (5.7%) and Cambridge (5.5%).
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At 3 yr after graduation, a significantly higher percentage of aspiring anaesthetists than others rated career and promotion prospects as having a great deal of influence on their choice of speciality. A significantly lower percentage of those who chose anaesthesia than others rated highly the influence of domestic circumstances, experience of the chosen subject as a student, or experience of jobs so far.
Because the influences on choices for general practice tend to be different from those for hospital specialties in the UK,3 we re-analysed the data in Table 4, for those choosing careers other than anaesthesia, excluding the responses of doctors whose first choice was general practice. This emphasized the finding that more of those choosing anaesthesia than those choosing other hospital careers were influenced a great deal by hours and working conditions.
Ten years after graduation
Ten years after graduation from UK medical schools, 60.9% of those whose sole first choice of long-term career was anaesthesia in year one, and 74.9% of those whose sole first choice was anaesthesia in year three, were working in anaesthesia (Table 5). Graduates who specified an equal preference for a career in either anaesthesia or another specialty (see Methods for explanation) were half as likely as those whose sole first choice was anaesthesia to be working in anaesthesia 10 yr after graduation (Table 5). Of those who were working in anaesthesia 10 yr after graduation, 48.8% (293/600) had chosen anaesthesia as their first choice of long-term career in year one, and 79.1% (451/570) had chosen anaesthesia in year three.
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Discussion |
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Career progression
In the past, the duration of time prior to obtaining a first consultant post was highly variable in the UK. Typically, in anaesthesia, it tended to be short relative to other specialties.10 In the mid-1990s, the British reforms to postgraduate medical training11 shortened the expected time of training for those in fulltime employment. Currently, progression to first consultant appointment takes around 8 yr after graduating from medical school (Table 6).12
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Factors influencing career choice
Three factors had a greater influence on choices for anaesthesia than on choices for other medical careers at both 1 and 3 yr after graduation from UK medical schools: the anticipated hours and working conditions, career and promotion prospects, and advice from others. With respect to hours and working conditions, compared with some other hospital specialties, anaesthesia has been perceived for years as a relatively family friendly hospital specialty with a history of well organized rota systems. However, as new ways of working in clinical practice are implemented, including the mandatory upper limits on working hours,15 anaesthesia may lose some of its perceived advantage as a family friendly hospital specialty over other hospital careers.
Experience of jobs undertaken so far was less influential in year one for those choosing anaesthesia than for those choosing other careers. This reflects, no doubt, the limited exposure to the work of anaesthesia in the pre-registration year. By year three, experience of jobs undertaken so far became almost as important for those choosing anaesthesia as it was for those making other career choices. In responses at the end of the pre-registration year, work experience was a more important determinant of career choice for other medical careers than for anaesthesia. This suggests that an increase in early opportunities to work in anaesthesia may have a beneficial effect on recruitment to the specialty. The new foundation years programme16 17 in UK medicine could be an opportunity to offer wider exposure and experience in anaesthesia to doctors at an early stage in their working careers.
Only one in thirty of those wanting a career in anaesthesia cited inclinations before medical school as a strong influence on their career choice. This was a much lower percentage than for other career choices within medicine. However, it is evident from our surveys that specialty preferences before entry to medical school are not a major determinant, generally, of doctors' eventual choice of specialty (Table 4).
Ten years after graduation
It is sometimes argued that early choices of long-term career are poor predictors of eventual career outcomes. However, two-thirds of those whose sole first choice was anaesthesia in their first year, and three-quarters of those whose sole first choice was anaesthesia in their third year after graduation, were working in the specialty 10 yr after graduation. Thus, a clear early choice for anaesthesia was a strong predictor of pursuing a subsequent career in the specialty. Concerns that the reform to the training grades, and perhaps particularly to the Senior House Officer grade,1618 will force young doctors into specialist schemes prematurely may be unfounded with respect to those who choose anaesthesia early in their careers, as many of those who made an early choice for anaesthesia did indeed pursue it as their career. It is important, however, that flexibility should remain for the large group who decide to pursue anaesthesia later in their junior years. For example, only 3.6% of those who chose careers other than anaesthesia at the end of the pre-registration year eventually went into anaesthesia. However, expressed as numbers rather than percentages, the number of such doctors (307, Table 5) is actually larger than the number who chose anaesthesia initially and eventually went into it (257, Table 5).
Future prospects
The number of new UK medical graduates who choose anaesthesia continues to increase and should ensure that the present level of production of 325350 trained anaesthetists each year8 is at least maintained in years to come. However, with consultant numbers set to expand to provide a fully consultant delivered service, it has been said that, at the current rate of training, it could take up to 12 yr to make up the current consultant deficit.7 There is a strong case for taking advantage of the increasing popularity of the specialty by increasing training numbers in the short term to speed up the process of providing a consultant delivered service.
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Acknowledgments |
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Footnotes |
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References |
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