Specialty choices among new generation of doctors - insights from a Polish survey study (2024)

Currently, healthcare systems around the world are facing serious labour crises, significant shortages, and unequal geographical distribution of doctors^1,2. One of the key issues in maintaining an adequate health workforce is young graduates’ choice of medical specialty. Their career choices substantially influence the future balance between different medical specialties. To better align the choices of young doctors with the needs of the healthcare system, we have to understand the differences between doctors who are already working and those who are only just starting. Three generations currently dominate the population of doctors in the workforce: the baby boomers (born 1945–1964), generation X (born 1965–1979), and generation Y (millennials: born 1980–1994)³. Each generation brings its characteristics to the medical profession. The baby boomers are known for working long hours and viewing medicine as a tireless vocation, while generations X and Y are more tech-savvy, value mobility, and prioritize work-life balance³.

Doctors currently entering the healthcare labour market (generation Z) were born between the late 1990s and early 2010s⁴. This generation, also known as‘Gen-Z’, differs significantly from older generations in many ways. Gen-Z individuals were born into a world of widespread access to information, largely due to the internet. They are proficient in using modern technologies, more focused on achieving a healthy work-life balance, and are more open to change in their lives compared to the generations of their parents and grandparents^5,6. The youngest generation of medical graduates is well prepared for clinical practice and the responsibilities associated with patient care. However, they do not accept the current state of workplace culture and working hours⁷. They strongly desire a life-work balance, flexibility in working conditions, and collaboration in the workplace. Although they have chosen a medical career, many young healthcare professionals report that their expectations are not being met, especially concerning non-clinical tasks, including the administrative burden⁸. They understand that the success of future healthcare systems is closely linked to the implementation of new technologies, recognizing its potential to reduce administrative workload and work-related stress. Besides salary, autonomy, collaboration, and technology play a crucial role in selecting a workplace (hospital or practice). To attract and retain this younger generation, healthcare organisations need to focus on team collaboration, a friendly working atmosphere, and adapt their work organisation practices accordingly⁴. In Poland, undergraduate medical education takes six years, following which all graduates must complete a compulsory postgraduate internship (13 months) and pass the State Medical Examination. Doctors who aim to specialize must undergo specialty/postgraduate training, which lasts between 4 and 6 years depending on the specialty, and then pass the State Specialization Exam. There are 77 recognized medical specialties, including surgical (such as general surgery, oncological surgery, urology, and vascular surgery), non-surgical (paediatrics, internal medicine, and their associated subspecialties, such as cardiology and endocrinology), and non-clinical specialties, including epidemiology and public health⁹. The Ministry of Health regularly publishes lists of available training positions in each specialty and the number of state-funded posts after consulting with regional authorities and national medical consultants. Doctors must successfully qualify by participating in a biannual qualification process overseen by a governmental organization. Positions are awarded based on merit, with preference given to doctors who accrue the highest points in the qualification process. This assessment considers factors such as performance on the state medical examination, contributions to scientific research, and additional academic qualifications, such as completion of a PhD.¹⁰.

In Poland, many specialties are experiencing a ‘generation gap’¹¹, which requires well-thought-out decisions to compensate for the forthcoming crisis that would become even more serious if doctors at retirement age were to stop working². Around the world, the youngest generation is changing key priorities and expectations, particularly their strong preference for better work-life balance and more supportive work environments, are becoming increasingly similar⁷. Therefore, the perspective of the next generation of doctors needs to be understood to mitigate the human resource crisis and to know how to encourage them to start their medical careers in the most deficient specialties.

This article aimed to provide evidence on the factors that drive young doctors to choose their future specialties, presenting differences between those applying for non-surgical specialties and those applying for surgical ones.

Ethics considerations

The concept and methodology of this study were approved by the Bioethical Committee of Jagiellonian University (approval number: 1072.6120.215.2022). This study was performed following the Declaration of Helsinki. In the first section of the questionnaire, all ethical aspects were explained. Respondents proceeded to complete the questionnaire only after reading the ethical guidelines and providing informed consent to participate in the study.

It was a nationwide, cross-sectional research. A quantitative, online survey was conducted between May and August 2023. To be included in our study, respondents had to be medical school graduates who were either currently undergoing a mandatory postgraduate internship or had finished it no earlier than October 2022. Medical students, doctors under residency training, and doctors with specialization were excluded. As decisions regarding the choice of medical specialty often change during medical studies¹², we decided to explore the topic among recent medical graduates and young doctors who have just started their first jobs as healthcare providers. We selected this group because these doctors are either on the brink of choosing their specialty or have recently made that decision. Consequently, we anticipated that the responses from the questionnaire would closely reflect the factors considered when making the actual choice. To ensure broad coverage of our survey’s target group, the study was broadly promoted using numerous social media channels dedicated to young doctors, famous and popular websites (i.e. Remedium¹³) as well as through the Polish Association of Doctors under Residency Training. This approach and wide promotion allowed us to reach potential respondents from all geographical Polish regions. Detailed instructions (providing the objective and implications of the study, its scientific nature, terms of anonymity, and confidentiality) with a link to the self-administered survey were included. Subsequently, two reminders were sent. Participation in the study was voluntary. The methodology and implemented measures align with established methodologies for improving response rates in doctors surveys, consistent with the best practices in surveying doctors advocated by Flanigan et al.¹⁴.

To guarantee sufficient reporting the STROBE checklist for cross-sectional studies was used (Supplementary File 1).

The tool used in our study was the questionnaire developed by the authors’ team. To ensure the validity and reliability of the questionnaire, two experts in the field were consulted on the draft version. The questionnaire was then pre-tested on a group of eight respondents (medical graduates) to guarantee the readability and clarity of the questions. It was a self-administered online survey divided into three main sections (Supplementary File 2):

• Personal information, including gender, age, marital status, having children, and place of living.

• Medical specialties: current specialty for doctors during specialty training and preferred specialty for doctors before specialty training. The list of medical specialties was developed based on the Minister of Health’s Executive Regulation on doctors’ and dentists’ medical specializations⁹.

• Factors taken into consideration during specialty choice. Respondents were asked how important the listed factors were, using a 5-point Likert scale (1 being the least important and 5 being the most important). A list of 19 potential factors influencing doctors’ choice of medical specialty was developed based on the literature review and our previous qualitative research, including in-depth interviews with 30 medical graduates⁷.

An important issue for our study was the division of specialties into surgical and non-surgical categories. A comprehensive review of international literature revealed a noticeable decline in the interest of young medical practitioners in pursuing surgical specializations worldwide, and several plausible explanations have been proposed^15,16,17. This observed trend was also evident in a study conducted among Polish medical students¹⁸. We had to establish a standardized categorization of medical specializations to conduct further analysis. The reviewed literature did not provide a consistent classification system, especially considering that certain specializations are unique to only a few countries (including Poland). To address this issue, researchers (RK and BM) devised a classification system, drawing upon examples extracted from both international sources¹⁹ and Polish literature¹⁸. Specialties were grouped into two categories: surgical and non-surgical (Supplementary File 3). The researchers independently evaluated the classified specializations, utilizing identified examples and training programs in each specialty. A key criterion for comparison involved examining whether a given specialization’s residency program required candidates to perform surgeries. Subsequently, the results obtained by each researcher were collated and compared. In cases of discrepancies, the researchers engaged in constructive discussions to reach a consensus on their findings.

Statistical analysis

Before analysis, the respondents were divided into two groups: (1) group A – those who have already started their specialty training and (2) group B - those who have yet to start. Independently, we compared results based on the specialty type: surgical or non-surgical. The data distribution was presented as numbers and percentages for categorical variables and means with SD for numerical variables. The U-Mann Whitney test was used to compare the distribution of 19 factors between analysed categorical variables or the chi-squared test was used if a trend was not observed. Two-sided P-values of < 0.05 were considered statistically significant. Analysis was performed using IBM Corp. software released in 2021 (IBM SPSS Statistics for Windows; version 28.0; IBM Corp, Armonk, NY, United States).

Sample characteristics

737 questionnaires were submitted by respondents, but 39 were excluded due to incomplete responses, thus 698 questionnaires were included in the analysis (Fig.1). The mean age was 26.7 years (SD = 1.38; min.25 and max. 32). The majority of the respondents were women (n = 423; 60.6%). In terms of the representativeness of our study sample more generally, the gender distribution is similar to the national sample (60.6% vs. 61.7%)¹⁰.

Most respondents declared single marital status (n = 511; 73.21%) and were childless (n = 653; 93.55%). Our sample includes respondents living in all 16 Polish geographical regions (in villages, small and big cities).

The participants were doctors who were currently undertaking their postgraduate internship (n = 354; 50.7%), had initiated their specialty training after October 2022 (n = 191, 27.4%), had completed their postgraduate internship but had not yet commenced specialty training (n = 46; 6.6%) or had yet to start their internship (n = 107; 15.3%). In total there were 507 (72.6%) individuals in group B, while group A had 191 respondents.

Among respondents currently undergoing specialty training (group A), the majority were pursuing non-surgical specialties (n = 149; 74.9%). Non-surgical specialties were also more popular as the first choice among those who are to start their specialty (n = 369; 74.0%).

Factors affecting doctors’ choices of future specialty

In the comprehensive analysis of 19 factors, six were identified as particularly significant: potential remuneration, the ability to maintain a healthy work-life balance, interest in a specific specialty, the ability to open a private practice, possessed skills, and the type of doctor-patient interaction. Conversely, seven other factors were considered as much less important by most of the respondents: family and peer pressure, prestige associated with a given specialty, the duration of specialty training, the risk of infection, and experiences gained during university education or after graduation. For detailed information on the relative importance of each factor, please refer to Fig.2.

The two groups differed statistically significantly in attributing importance to the factors in eight items. Group B in comparison to group A assigned more weight to the availability of residency positions (21.4% vs. 4.6% gave the highest possible rating, p = 0.01), the requirement of overnight and weekend shifts (the lowest possible importance was given by 22.6% group A and 18% of group B, p = 0.05), the ability to start a practice (32.7% of group B gave it a rating of 5, while only 24.6% of group A gave the same importance, p = 0.02), the length of specialty training (the lowest importance was given by 54.3% of group A and 44.5% of group B, p = 0.04), the risk of infection (62.3% of group A marked it as the lowest possible importance, while only 50.3% of group B gave it a similar rating, p = 0.04), potential specialty mentor (38.7% of group A gave it the lowest possible importance, while only 23% of group B, p < 0.01).

Conversely, for those who have already started their residency, more importance was attributed to peer pressure (2% of group A rated it as 5, while only 0.6% of group B, p = 0.03) and prestige (9% of group A rated it as 5, while only 4.2% of group B, p = 0.02).

Differences between surgical and non-surgical specialties

We conducted separate analyses to assess the differences in the importance of factors within groups A and B. Within each group, we compared the importance of factors for those who chose surgical specialties as their first preference and those who preferred non-surgical specialties.

In the case of six factors, the differences in importance were statistically significant for both groups. However, for eight factors, the differences were significant in only group B. There were no factors in which there was a statistically significant difference in only group A.

The factors that exhibited statistically significant differences between individuals preferring or practicing non-surgical and surgical specialties in both groups were as follows: non-surgical specialties were associated with giving more weight to maintaining a healthy work-life balance, the risk of legal liability, the requirement of performing weekend and overnight shifts, the mental burden of a given specialty, the length of specialty training, and experiences from medical school (Table1).

In the case of eight factors, differences in importance between surgical and non-surgical specialties were statistically significant in group B, but not significant in group A. Choosing a surgical specialty as their first preference was associated with giving more importance to potential remuneration, interest in the chosen specialty, ability to start practice, prestige of the specialty, and potential mentors. At the same time, a preference for surgical specialty was associated with giving less importance to the availability of residency slots, family pressure, and the type of patient-doctor interaction (Table2).

In this study, we present the most crucial factors considered by representatives of Generation Z when choosing their specialty. We determined that doctors pursuing a career in surgical fields are driven by other factors than those who chose a non-surgical specialty. Work-related aspects were more significant for surgical-focused doctors, while more personal and life-related aspects were more typical for those pursuing non-surgical interests.

Overall, the factors considered when choosing a future specialty are mostly work-related. Doctors are willing to continue their careers in line with their interests and skills. They expect to maintain a proper balance between work and personal life and be adequately paid for their work. Young doctors seem to be aware of their limitations in terms of possessed communication skills, as they consider the type of patients interactions significant. Little attention is paid to more external factors, like family or peer pressure, prestige, or duration of training. Surprisingly, the experience gained during medical school does not influence their choices.

Non-surgical specialties have been more popular among doctors recently. The national authorities and representatives of the surgical association have highlighted the crisis in surgery²⁰. The data from past qualifications (held in previous years) objectivized those statements. In the latest qualifications, many posts in surgical specialties (mostly general surgery) remained unmatched. On the other hand, some surgical programmes (e.g. urology or obstetrics and gynaecology) received significant interest from candidates²¹.

The ability to maintain a healthy work-life balance is becoming one of the most meaningful aspects taken into consideration by young people in their occupational life. They do not want to devote their personal life to their work and employer. As presented by Spooner at al.²², young doctors find exploring their non-medical interests, spending time with friends and family more significant than spending long hours at work, even though it may mean having to abandon their initial career choices. Nowadays, doctors present a more holistic and long-term perspective on life. In the study, the respondents underlined that the attitude of life of those aged 25 is different from one may have when they are 45.

Surgical specialties are said to be more time-consuming and physically demanding. The training requires mentoring, long hours of practice, and persistence. Moreover, very little is said about support for young parents. What was not shown in our study, but has been proven by Dason et al.²³ is that students are concerned about developing families and how it would affect their occupational activities and relationships with colleagues and subsequently, their specialty choice.

New technologies, including artificial intelligence (AI) will undoubtedly become a significant part of the education and daily work of health professionals. So far, little research has been conducted exploring the impact of AI and new technologies on specialty choices. Gong et al.²⁴ presented that Canadian medical students had been discouraged from choosing radiology as a specialty, in contrast to the results of Pawelczyk et al. with regards to orthopaedic surgery²⁵. Atalay et al.²⁶ presented their results from 2017 to 2021 questionnaires indicating that medical students believe that emerging technologies would reduce job prospects in some specialties, including diagnostic radiology, pathology, and anesthesiology. Despite the studies conducted on the topic so far, further research is needed to understand the potential impact of new technologies on medical specialties.

This study reflects new insights and key factors taken into consideration by doctors of the younger generation while considering their careers. To our knowledge, it was the first nationwide quantitative study on this topic in Poland. The findings presented in the study are consistent with international research conducted on this topic^{27,28,29,30,31}. Therefore, the results may apply not only to Poland, but also to other countries. In a Brazilian study³² the authors presented that students reject and choose their preferred specialty in different periods, including controllable lifestyle specialties (e.g. neurology, ophthalomology, pathology) being chosen mainly during the last two years of education. The UK cohort study presented that socioeconomic background plays a crucial role when choosing a specialty³³.

The study provided a valuable source of information for policymakers and authorities to mitigate the crisis in the healthcare workforce. One challenge facing healthcare systems around the world is the education crisis^34,35, which refers to the inadequacy of educational institutions to properly train and prepare new generations of healthcare professionals¹. The results of an international study provide a clear mandate for healthcare managers to address the concerns of the younger generation of healthcare professionals. It emphasizes three critical areas that require urgent attention: education and training, technology, and work culture⁸. Educational institutions need to update their curricula and training programs to equip medical students with the necessary skills and competencies to meet the current and future demands of the healthcare system. Consequently, there is a gap between the education health workers receive and the practical needs of the health sector, leading to the health workforce that is not fully prepared to address the growing challenges in healthcare^1,2,7,8. In light of the aforementioned findings and the existing literature, it is evident that there is a pressing need for further international research on the topic of specialty choices among young doctors. A more comprehensive study on a larger scale is required to gain a deeper understanding of the preferences of Gen Z doctors. Nevertheless, the presented factors are beneficial to stakeholders and policymakers. These aspects should be acknowledged while planning reforms in medical education and capacity in human resources, which would be resilient against the challenges posed by the changing health needs of populations.

Our study is not free of limitations. The data collected were obtained from doctors whose medical school experience was conducted partially during the COVID-19 pandemic, having much of the teaching held online, limiting their access to clinical experiences. Secondly, we included a specific cohort of Polish doctors that may vary from older trainees, still, we aimed to reach those who have not had much work experience yet. The next limitation is the potential bias in responses, as an online survey may have resulted in different interpretations of the questions by respondents. While an online, self-administered survey has some limitations, benefits include accessing nationally geographically distributed respondents that would be difficult for an in-person questionnaire.

This research highlights the need for further investigation into the topic. The respondents, even though they have not been part of the system for a long time, will become the majority soon, changing the landscape of the health workforce. Policymakers should be able to communicate and answer their expectations and perspectives.

Author notes

1. These authors contributed equally: Robert Kupis and Beniamin Michalik

Authors and Affiliations

1. Centre for Innovative Medical Education, Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland

   Robert Kupis

2. NZOZ SANA-MED, Kraków, Poland

   Beniamin Michalik

3. Faculty of Health Sciences, Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, Kraków, Poland

   Maciej Polak

4. 5th Military Clinical Hospital, Kraków, Poland

   Mateusz Kulbat

5. Department of Health Policy and Management, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland

   Alicja Domagała

Contributions

Conceptualization, B.M., R.K and A.D.; Data collection, R.K., B.M. and M.K.; Formal analysis, M.P., B.M and R.K.; Methodology, B.M., R.K., M.P. and A.D.; Project administration, B.M; Resources, A.D.; Supervision, A.D.; Visualization, M.B., R.K.; Writing—original draft, R.K., B.M., M.P., M.K and A.D, Writing—review & editing, R.K., B.M. and A.D. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alicja Domagała.

Competing interests

The authors declare no competing interests.

Ethical approval

The research methodology was approved by the Bioethical Committee of Jagiellonian University (approval number: 1072.6120.215.2022).

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions