Factors that affect general practice as a choice of medical speciality: implications for policy developmentAmit Vohra A D , Richard Ladyshewsky B and Stephen Trumble C
A Sonic Clinical Services Pty Ltd, Level 32, 60 Margaret Street, Sydney, NSW 2000, Australia.
B Curtin Business School, Curtin Graduate School of Business, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email: firstname.lastname@example.org
C Department of Medical Education, Level 7 East Melbourne Medical School, University of Melbourne, VIC 3010, Australia. Email: email@example.com
D Corresponding author. Email: firstname.lastname@example.org
Australian Health Review - https://doi.org/10.1071/AH17015
Submitted: 20 February 2017 Accepted: 4 October 2017 Published online: 28 November 2017
Objective This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners.
Methods This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice.
Results The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work–life balance, scope of practice, connection with patients, training environment and practical opportunities did.
Conclusion The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual.
What is known about the topic? Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other.
What does this paper add? The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a ‘hygiene factor’.
What are the implications for policy makers? A policy framework outlining 10 key principles is presented to assist policy makers seeking to affect workforce outcomes by applying policy levers to influence doctors’ choice of speciality.
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