Trevor W Lambert

Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983

Abstract Objective: To report the career preferences of doctors who qualified in the United Kingdom in 1993 and to compare their choices with those of earlier cohorts of qualifiers. Design: Postal questionnaires with structured questions, including questions about choice of future long term career, were sent to doctors a year after qualification. Setting: United Kingdom. Subjects: All medical qualifiers of 1993, comparing their replies with those from earlier studies of the qualifiers of 1974, 1977, 1980, and 1983. Main outcome measures: Choice of future long term career and certainty of choice expressed at the end of the first year after qualification. Results: Questionnaires were sent to 3657 doctors. 2621 (71.7%) replied. Of the 2621 respondents, 70.5% (1849) stated that their first preference was for a career in hospital practice, 25.8% (677) specified general practice, 1.0% (25) specified public health medicine or community health, 1.4% (36) specified careers outside medicine, and 1.3% (34) did not state a choice. By contrast, 44.7% (1416/3168) of the doctors in the 1983 cohort had specified that their first preference was general practice. Among the 1993 qualifiers, general practice was the first career choice of 17.5% of men (227/1297) and 34.0% of women (450/1324). Only 7.4% of men (96/1297) stated that they definitely wanted to enter general practice. Only 7.8% (103/1324) of women qualifiers in 1993 expressed a career preference for surgical specialties. Within hospital practice, comparing 1993 with 1983, choices for the medical specialties and for accident and emergency medicine rose and those for pathology fell. Women were less definite than men about their choice of future long term career. Conclusions: If the 1993 cohort is typical of the current generation of young doctors, there has been a substantial shift away from general practice as a career choice expressed at the end of the preregistration year. General practice was much more popular among women than men. Few women opted for surgery. The sex imbalance in the percentage of doctors who choose different mainstreams of medical practice seems set to continue.

Career choices of United Kingdom medical graduates of 1999 and 2000: questionnaire surveys

The career choices of doctors at the end of their preregistration year have been studied for doctors who qualified in the United Kingdom in 1974, 1977, 1980, 1983, 1988, 1993 and 1996.1–4 We report here on the graduates of 1999 and 2000. The survey population comprised all graduates from all medical schools in the United Kingdom in 1999 and 2000. We used graduation lists from each medical school to compile our database. The doctors were sent a questionnaire towards the end of their preregistration year; non-respondents were sent a maximum of four reminders. As in earlier surveys,1–4 graduates were asked to state up to three choices of long term career in order of …

Career choices at the end of the pre‐registration year of doctors who qualified in the United Kingdom in 1996

To report the career intentions one year after qualification of doctors who qualified in the United Kingdom (UK) in 1996, and to compare their intentions with those of 1993 qualifiers at the same stage.

Career choices of United Kingdom medical graduates of 2002: questionnaire survey

Objectives  To report the specialty choices of UK medical graduates of 2002, and to compare their choices with those of qualifiers in previous years and with the profile of career grade doctors in different specialties in England.

Doctors' reasons for rejecting initial choices of specialties as long-term careers

Objectives  To report on rejected choices of specialty as long‐term careers and reasons for rejection.

Medical graduates’ early career choices of specialty and their eventual specialty destinations: UK prospective cohort studies

Objective To report on doctors’ early choices of specialty at selected intervals after qualification, and eventual career destinations. Design Questionnaire surveys. Setting United Kingdom. Participants Total of 15 759 doctors who qualified in 1974, 1977, 1983, 1993, and 1996, and their career destinations 10 years after graduation. Results 15 759 doctors were surveyed one and three years after graduation and 12 108 five years after graduation. Career preferences at years 1, 3, and 5, and destinations at 10 years, were known for, respectively, 64% (n=10 154), 62% (n=9702), and 61% (n=7429) of the survey population. In the 1993 and 1996 cohorts, career destinations matched with year 1 choices for 54% (1890/3508) of doctors in year 1, 70% (2494/3579) in year 3, and 83% (2916/3524) in year 5. Corresponding results for the earlier cohorts (1974-83) were similar: 53% (3310/6264), 74% (4233/5752), and 82% (2976/3646). The match rates varied by specialty; for example, the rates were consistently high for surgery. Career destinations matched with year 1 choices for 74% (722/982) of doctors who specified a definite (rather than probable or uncertain) specialty choice in their first postgraduate year. About half of those who chose a hospital specialty but did not eventually work in it were working in general practice by year 10. Conclusions Ten years after qualification about a quarter of doctors were working in a specialty that was different from the one chosen in their third year after graduation. This stayed reasonably constant across graduation cohorts despite the changes in training programmes over time. Subject to the availability of training posts, postgraduate training should permit those who have made early, definite choices to progress quickly into their chosen specialty, while recognising the need for flexibility for those who choose later.

Country of training and ethnic origin of UK doctors: database and survey studies.

Abstract Objectives To report on the country of training and ethnicity of consultants in different specialties in the NHS, on trends in intake to UK medical schools by ethnicity, and on the specialty choices made by UK medical graduates in different ethnic groups. Design Analysis of official databases of consultants and of students accepted to study medicine; survey data about career choices made by newly qualified doctors. Setting and subjects England and Wales (consultants), United Kingdom (students and newly qualified doctors). Results Of consultants appointed before 1992, 15% had trained abroad; of those appointed in 1992-2001, 24% had trained abroad. The percentage of consultants who had trained abroad and were non-white was significantly high, compared with their overall percentage among consultants, in geriatric medicine, genitourinary medicine, paediatrics, old age psychiatry, and learning disability. UK trained non-white doctors had specialty destinations similar to those of UK trained white doctors. The percentage of UK medical graduates who are non-white has increased substantially from about 2% in 1974 and will approach 30% by 2005. White men now comprise little more than a quarter of all UK medical students. White and non-white UK graduates make similar choices of specialty. Conclusions Specialist medical practice in the NHS has been heavily dependent on doctors who have trained abroad, particularly in specialties where posts have been hard to fill. By contrast, UK trained doctors from ethnic minorities are not over-represented in the less popular specialties. Ethnic minorities are well represented in UK medical school intakes; and white men, but not white women, are now substantially under-represented.

Career progression and destinations, comparing men and women in the NHS: postal questionnaire surveys.

Objective To study the career progression of NHS doctors, comparing men and women. Design Postal questionnaire surveys. Participants and setting Graduates of 1977, 1988, and 1993 from all UK medical schools. Results The response rate was 68% (7012/10 344). Within general practice, 97% (1208/1243) of men, 99% (264/267) of women who had always worked full time throughout their career, and 87% (1083/1248) of all women were principals. Median times from qualification to principal status were 5.8 (95% confidence interval 5.6 to 6.0) years for men, 5.6 (5.4 to 5.8) years for women who had worked full time during training, and 6.8 (6.5 to 7.0) years for all women. Of the 1977 and 1988 graduates in hospital practice, 96% (1293/1347) of men were consultants, compared with 92% (276/299) of women who had always worked full time throughout their career and 67% (277/416) of women who had not. Median time to first consultant post was 11.7 (11.5 to 11.9) years for men, 11.3 (11.0 to 11.6) years for women who worked full time during training, and 12.3 (12.0 to 12.6) years for all women. Women who had not always worked full time throughout their career were over-represented in general practice and under-represented in most hospital specialties, substantially so in the surgical specialties and anaesthetics. Women who had always worked full time were under-represented not only in the surgical specialties but also in general practice. Conclusions Women not progressing as far and as fast as men was, generally, a reflection of not having always worked full time rather than their sex. The findings suggest that women do not generally encounter direct discrimination; however, the possibility that indirect discrimination, such as lack of opportunities for part time work, has influenced choice of specialty cannot be ruled out.

Effect of spectacles on changes of spherical hypermetropia in infants who did, and did not, have strabismus

AIM To explore why emmetropisation fails in children who have strabismus. METHODS 289 hypermetropic infants were randomly allocated spectacles and followed. Changes in spherical hypermetropia were compared in those who had strabismus and those who did not. The effect of wearing glasses on these changes was assessed using t tests and regression analysis. RESULTS Mean spherical hypermetropia decreased in both eyes of “normal” children (p<0.001). The consistent wearing of glasses impeded this process in both eyes (p<0.007). In the children with strabismus, there were no significant changes in either eye, irrespective of treatment (p>0.05). CONCLUSIONS In contrast with normal infants, neither eye of those who had strabismus emmetropised, irrespective of whether the incoming vision was clear or blurred. It is suggested that these eyes did not “recognise” the signal of blurred vision, and that they remained long sighted because they were destined to squint. Hence, the children did not squint because they were long sighted, and glasses did not prevent them squinting.

Choice and rejection of psychiatry as a career: surveys of UK medical graduates from 1974 to 2009

Background Recruitment of adequate numbers of doctors to psychiatry is difficult. Aims To report on career choice for psychiatry, comparing intending psychiatrists with doctors who chose other clinical careers. Method Questionnaire studies of all newly qualified doctors from all UK medical schools in 12 qualification years between 1974 and 2009 (33 974 respondent doctors). Results One, three and five years after graduation, 4–5% of doctors specified psychiatry as their first choice of future career. This was largely unchanged across the 35 years. Comparing intending psychiatrists with doctors who chose other careers, factors with a greater influence on psychiatrists’ choice included their experience of the subject at medical school, self-appraisal of their own skills, and inclinations before medical school. In a substudy of doctors who initially considered but then did not pursue specialty choices, 72% of those who did not pursue psychiatry gave ‘job content’ as their reason compared with 33% of doctors who considered but did not pursue other specialties. Historically, more women than men have chosen psychiatry, but the gap has closed over the past decade. Conclusions Junior doctors’ views about psychiatry as a possible career range from high levels of enthusiasm to antipathy, and are more polarised than views about other specialties. Shortening of working hours and improvements to working practices in other hospital-based specialties in the UK may have reduced the relative attractiveness of psychiatry to women doctors. The extent to which views of newly qualified doctors about psychiatry can be modified by medical school education, and by greater exposure to psychiatry during student and early postgraduate years, needs investigation.