Gender difference in preference of specialty as a career choice among Japanese medical students

Research article Open Access Open Peer Review Gender difference in preference of specialty as a career choice among Japanese medical students Ryuichi Kawamoto1, 2Email author, Daisuke Ninomiya1, 2, Yoshihisa Kasai2, Tomo Kusunoki2, Nobuyuki Ohtsuka2, Teru Kumagi1 and Masanori Abe1 BMC Medical EducationBMC series – open, inclusive and trusted201616:288 https://doi.org/10.1186/s12909-016-0811-1 ©  The Author(s). 2016 Received: 11 May 2016Accepted: 1 November 2016Published: 10 November 2016 Open Peer Review reports Abstract Background In Japan, the absolute deficiency of doctors and maldistribution of doctors by specialty is a significant problem in the Japanese health care system. The purpose of this study was to investigate the factors contributing to specialty preference in career choice among Japanese medical students. Methods A total of 368 medical students completed the survey giving an 88.2 % response rate. The subjects comprised 141 women aged 21 ± 3 (range, 18–34) years and 227 men aged 22 ± 4 (range, 18–44) years. Binary Logistic regression analysis was performed using specialty preferences as the criterion variable and the factors in brackets as six motivational variables (e.g., Factor 1: educational experience; Factor 2: job security; Factor 3: advice from others; Factor 4: work-life balance; Factor 5: technical and research specialty; and Factor 6: personal reasons). Results Women significantly preferred pediatrics, obstetrics & gynecology, and psychology than the men. Men significantly preferred surgery and orthopedics than the women. For both genders, a high odds ratio (OR) of “technical & research specialty” and a low OR for “personal reasons” were associated with preference for surgery. “Technical & research specialty” was positively associated with preference for special internal medicine and negatively for pediatrics. “Work-life balance” was positively associated with preference for psychology and negatively for emergency medicine. Among the women only, “technical & research specialty” was negatively associated with preference for general medicine/family medicine and obstetrics & gynecology, and “job security” was positively associated for general medicine/family medicine and negatively for psychology. Among men only, “educational experience” and “personal reasons” were positively, and “job security” was negatively associated with preference for pediatrics. For both genders, “work-life balance” was positively associated with preference for controllable lifestyle specialties. Conclusion We must acknowledge that Japanese medical students have dichotomized some motivations for their specialty preference based on gender. Systematic improvements in the working environment are necessary to solve these issues. Keywords Career choiceGender differenceJapanese medical students Background In Japan, there have been absolute deficiencies in the number of physicians. This number of doctors belongs to the lowest group in the Organization for Economic Co-operation and Development (OECD) [1]. In addition to the absolute deficiency of doctors, maldistribution of doctors among the various specialties is a serious problem in the Japanese health care system. A Japanese governmental report revealed that obstetrics & gynecology, pediatrics, and anesthesiology have suffered a more severe shortage than other specialties [2]. Moreover, the decreasing tendency of doctors to choose internal medicine and surgery has accelerated [3]. In Japan, internal medicine showed the highest preference rate, followed by general surgery, pediatrics, and emergency medicine. The gender ratio varied according to the specialty [4], and the preference rates for general surgery, orthopedics, neurosurgery, and emergency medicine were significantly higher in men than in women, while those for obstetrics & gynecology, pediatrics, and dermatology were significantly higher in women [5]. Women now account for about one third to half of medical students and have become a growing part of medical schools in Japan as well as the U.S. and Europe [6, 7], however female physicians are still underrepresented in some specialties such as surgery and emergency medicine [8]. Choosing a specialty is a complex process and may be influenced by several confounding factors. Distribution of medical students’ career choices among specialties varies considerably. Recent studies in other countries identified several factors related to the choice and preference, such as gender, career opportunities, prestige, and income [9–11]. Enoch et al. demonstrated that specialties that feature a controllable lifestyle (control of work hours) were defined as anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, otolaryngology, pathology, psychiatry, and radiology, while non-controllable lifestyle specialties were surgery, internal medicine, family practice, pediatrics, orthopedic surgery, and obstetrics & gynecology [12]. In the USA, interest in surgery, pediatrics, and obstetrics & gynecology has declined, but the popularity of controllable lifestyle fields such as radiology, psychiatry, dermatology, and ophthalmology has been increasing [13]. Controllable lifestyle is becoming an increasingly important factor in choice of specialty by medical students. Moreover, for surgical careers, the decision to have a family (e.g., children) was a more significant influence for women than men [14]. Thus, it is important to know the expectations of future physicians as they play a role in their career choice. There are many studies on career choice of medical students in Western countries. However, studies exploring the impact of gender differences regarding specialty preferences in career choice are still lacking in Japan. The purpose of this study was to compare specialty preferences and the motivational factors of Japanese medical students. We investigated associations between motivational factors and specialty preference in order to determine the factors contributing to specialty preferences as a career. Methods Participants We cross-sectionally conducted a survey of 1st to 5thyear medical students (N = 450) from one Japanese regional university school of medicine. From April 2009 to 2013 (in Japan, the academic year begins in April), the self-administered questionnaire was distributed and collected in class within the first 4 weeks of the start of medical school. Individual responses required a signature (anonymous responses were also permitted), and completion of the questionnaire was voluntary. The study was approved by the ethics committee of the Ehime University Graduate School of Medicine (IRB: 1507004), and informed consent was obtained from all subjects. Questionnaire We used a modified questionnaire enquiring about their specialty preference and to what extent their decision was influenced by a set of given criteria that were developed by Takeda et al. [15] (...truncated)