‘controllable lifestyle’ proves key to specialty choices

Jama: ‘controllable lifestyle’ proves key to specialty choices

The reputation of each specialty for a “controllable lifestyle”–stemming from control over and amount of total weekly hours spent on professional responsibilities by practitioners in each field, and from their amount of call duty–has become the key factor in U.S. medical students’ choice of residencies to pursue, researchers at Northwestern University Medical School in Chicago contend.

Writing in the Sept. 3 Journal of the American Medical Association, the researchers, led by Ray Dorsey, M.D., compared recent results of the National Residency Match Program (NRMP, 1997 to 2001) with various specialties’ “controllable” status. Considering a field’s actual time demands and its reputation for having or lacking a controllable lifestyle, Dorsey rated as “uncontrollable” all primary care fields along with orthopedic and general surgery, urology, and ob/gyn.

The major fields he rated as having a “controllable lifestyle” were anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, ENT surgery, pathology, psychiatry and radiology. He did not rate cardiology either way.

He also added into the analysis a typical pay figure for each specialty, an average number of weekly work hours, and the number of years of required graduate medical education, to see the role these factors played in senior med students’ match choices.

Running a regression analysis, Dorsey found that controllable lifestyle explained more than half the variation in the med students’ first choices for placement in the NRMP. “Generation X” physicians are well known to have strong concerns about time for their personal lives (PCR 2/03, p. 11).

Money, Job Market Also Important

Ed Salsberg, director of the Center for Health Workforce Studies at the University of Albany (N.Y.) School of Public Health, says Dorsey’s research is good, but medical students and residents also are very concerned about pay levels and the strength of the job market in various specialties.

Salsberg’s office has been surveying trainees at a different stage of their education–in the last month of residency–annually for several years. He has generated data on whether the residents have a job; if so, what kind and what it pays; or whether they’re going on to a fellowship. The respondents are from all the residency and fellowship programs in New York state; in 2002, about 3,100 responded, representing 70% of the roughly 4,450 grads of such programs. Salsberg has similar data for California residency and fellowship grads.

“If you have [an] uncontrollable lifestyle and [relatively] low pay,” says Salsberg, “you have two strikes against you.” That is the situation for some jobs in primary care, he says.

Pathology has a controllable lifestyle but fairly low pay, he adds, so it is in an intermediate situation.

Some fields such as anesthesiology, radiology, dermatology, radiation oncology, and ophthalmology have controllable lifestyle and relatively high income, he notes, making them extremely popular among graduating med students.

Another major factor for med students and residents in choosing specialties and making future plans is the strength of the job market in each field, Salsberg adds. They want to have several job offers to be able to choose one that seems very desirable, he explains.

Contact Salsberg at ess02@health.state.ny.us or (518) 402-0250.

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