Early career choices for emergency medicine and later career destinations: national surveys of UK medical graduates.

OBJECTIVE: To report doctors' early career preferences for emergency medicine, their eventual career destinations and factors influencing their career pathways. DESIGN: Self-administered questionnaire surveys. SETTING: United Kingdom. PARTICIPANTS: All graduates from all UK medical schools in selected graduation years between 1993 and 2015. MAIN OUTCOME MEASURES: Choices for preferred eventual specialty; eventual career destinations; certainty about choice of specialty; correspondence between early specialty choice for emergency medicine and eventually working in emergency medicine. RESULTS: Emergency medicine was chosen by 5.6% of graduates of 2015 when surveyed in 2016, and 7.1% of graduates of 2012 surveyed in 2015. These figures represent a modest increase compared with other recent cohorts, but there is no evidence of a sustained long-term trend of an increase. More men than women specified emergency medicine - in 2016 6.6% vs. 5.0%, and in 2015 7.9% vs. 6.5%. Doctors choosing emergency medicine were less certain about their choice than doctors choosing other specialties. Of graduates of 2005 who chose emergency medicine in year 1, only 18% were working in emergency medicine in year 10. Looking backwards, from destinations to early choices, 46% of 2005 graduates working in emergency medicine in 2015 had specified emergency medicine as their choice of eventual specialty in year 1. CONCLUSIONS: There was no substantial increase across the cohorts in choices for emergency medicine. Policy should address how to encourage more doctors to choose the specialty, and to create a future UK health service environment in which those who choose emergency medicine early on do not later change their minds in large numbers.

Junior doctors' aspirations for careers in ophthalmology: 40 years of surveys of UK medical graduates.

OBJECTIVE: Using data from 40 years of national surveys of UK medical graduates, we report on ophthalmology as a career choice. DESIGN SETTING AND PARTICIPANTS: Self-administered questionnaire surveys of all graduates from all UK medical schools in selected years of qualification between 1974 and 2015. MAIN OUTCOME MEASURES: Career specialty preferences of doctors one, three, and five years after graduation; career specialty destinations 10 years after graduation. RESULTS: One year after graduation, ophthalmology was the first career preference of 1.6% of the qualifiers of 1974-83, 2.2% of 1993-2002, and 1.8% of 2005-15. The corresponding percentages three years after graduation were 1.5, 1.8, and 1.2%. Men were more likely than women to choose ophthalmology: among graduates of 2005-15, 2.4% of men and 1.4% of women did so at one year, as did 1.7% of men and 0.7% of women at five years. Seventy per cent of doctors practising as ophthalmologists 10 years after qualification had told us in their first post-qualification year that ophthalmology was their first choice of career. CONCLUSIONS: There has been no systematic change in recent years in the proportion of recent medical graduates intending to have a career in ophthalmology when surveyed one year after graduation. However, the proportion at three and five years after graduation was lower than that at year 1. Suggestions for maintaining interest in the specialty include improved career advice, greater early clinical exposure to ophthalmology, and improved access to flexible training. Most practising ophthalmologists had made early decisions that this was their intended career.

Career choices for obstetrics and gynaecology: recent updates from 40 years of national surveys of UK medical graduates.

OBJECTIVE: To report doctors' early career choices for obstetrics and gynaecology, their eventual career destinations and factors influencing their career pathways. DESIGN: Multi-cohort multi-purpose national questionnaire surveys of medical graduates in selected graduation years between 1974 and 2015. SETTING: UK. PARTICIPANTS: UK-trained medical graduates. MAIN OUTCOME MEASURES: Career specialty choices; certainty about specialty choice; factors which influenced doctors' career choices; career specialty destinations 10 years after graduation. RESULTS: Obstetrics and Gynaecology was the first choice of career for 5.7% of post-2002 graduates in year 1, 4.3% in year 3 and 3.8% in year 5. A much higher percentage of women than men specified Obstetrics and Gynaecology as their first choice: in year 1, 7.7% of women and 2.3% of men did so. The gender gap has widened since the 1970s and 1980s. In recent years, of those who specified Obstetrics and Gynaecology as their first choice in year 1 after graduation, 48% were working in Obstetrics and Gynaecology in year 10 (63% of men, 45% of women). Looking backwards from career destinations, 85% of doctors working in Obstetrics and Gynaecology in year 10 had specified Obstetrics and Gynaecology as a first, second or third choice of preferred career in year 1. CONCLUSIONS: Interest in Obstetrics and Gynaecology among UK graduates appears to be exceeding the demand for new specialists. Policy needs to address risks of over-production of trainees and ensure that some graduates interested in Obstetrics and Gynaecology consider alternative careers. The large gender imbalance should encourage consideration of the reasons for men choosing Obstetrics and Gynaecology in falling numbers.

Junior doctors' early career choices do not predict career destination in neurology: 40 years of surveys of UK medical graduates.

BACKGROUND: The rapidly rising rates of brain diseases due to the growing ageing population and the explosion in treatment options for many neurological conditions increase the demand for neurologists. We report trends in doctors' career choices for neurology; investigate factors driving their choices; and compare doctors' original choices with their specialty destinations. METHODS: A multi-cohort, multi-purpose nation-wide study using both online and postal questionnaires collected data on career choice, influencing factors, and career destinations. UK-trained doctors completed questionnaires at one, three, five, and ten years after qualification. They were classified into three groups: graduates of 1974-1983, graduates of 1993-2002, and graduates of 2005-2015. RESULTS: Neurology was more popular among graduates of 2005-2015 than earlier graduates; however, its attraction for graduates of 2005-2015 doctors reduced over time from graduation. A higher percentage of men than women doctors chose neurology as their first career choice. For instance, among graduates of 2005-2015, 2.2% of men and 1.1% of women preferred neurology as first choice in year 1. The most influential factor on career choice was "enthusiasm for and commitment to the specialty" in all cohorts and all years after graduation. Only 39% who chose neurology in year 1 progressed to become neurologists later. Conversely, only 28% of practicing neurologists in our study had decided to become neurologists in their first year after qualification. By year 3 this figure had risen to 65%, and by year 5 to 76%. CONCLUSIONS: Career decision-making among UK medical graduates is complicated. Early choices for neurology were not highly predictive of career destinations. Some influential factors in this process were identified. Improving mentoring programmes to support medical graduates, provide career counselling, develop professionalism, and increase their interest in neurology were suggested.

Views of UK doctors in training on the timing of choosing a clinical specialty: quantitative and qualitative analysis of surveys 3 years after graduation.

BACKGROUND: Workforce studies show a declining proportion of UK junior doctors proceeding directly to specialist training, with many taking career breaks. Doctors may be choosing to delay this important career decision. AIM: To assess doctors' views on the timing of choosing a clinical specialty. METHODS: Surveys of two cohorts of UK-trained doctors 3 years after qualification, in 2011 and 2015. RESULTS: Presented with the statement 'I had to choose my career specialty too soon after qualification', 61% agreed (27% strongly) and 22% disagreed (3% strongly disagreed). Doctors least certain about their choice of specialty were most likely to agree (81%), compared with those who were more confident (72%) or were definite regarding their choice of long-term specialty (54%). Doctors not in higher specialist training were more likely to agree with this statement than those who were (72% vs 59%). Graduate medical school entrants (ie, those who had completed prior degrees) were less likely to agree than non-graduates (56% vs 62%). Qualitative analysis of free text comments identified three themes as reasons why doctors felt rushed into choosing their future career: insufficient exposure to a wide range of specialties; a desire for a greater breadth of experience of medicine in general; and inadequate career advice. CONCLUSIONS: Most UK-trained doctors feel rushed into choosing their long-term career specialty. Doctors find this difficult because they lack sufficient medical experience and adequate career advice to make sound choices. Workforce trainers and planners should enable greater flexibility in training pathways and should further improve existing career guidance.

Career choices for nephrology and factors influencing them: surveys of UK medical graduates.

OBJECTIVES: To study early and eventual career choices for nephrology among UK medical graduates and investigate factors which influenced career preferences. DESIGN: Self-completed survey questionnaires mailed to medical graduates 1, 3, 5 and 10 years after graduation. SETTING: United Kingdom. PARTICIPANTS: UK medical graduates in 15 year-of-qualification cohorts between 1974 and 2015. MAIN OUTCOME MEASURES: Early career specialty choices, career specialty destinations at 10 years and ratings of factors affecting career choices. RESULTS: Around 0.4%-1.1% of these junior doctors expressed a career preference for nephrology, varying by year of qualification and years after qualification. Among all graduates of 1993-2002 combined, 0.4% expressed a career preference for nephrology 1 year after qualification rising to 1.0% in year 5. Among graduates of 2005-2008, the corresponding figures were 1.0% in year 1 falling to 0.7% in year 5. Only 18% of doctors who chose nephrology in year 1 eventually became nephrologists. Of doctors who were practising as nephrologists for 10 years and more after qualification, 74% of the women and 56% of the men had decided to pursue a career in nephrology by year 5 after qualification. 'Enthusiasm/commitment' had a great deal of influence on those who chose nephrology, for all cohorts and all years studied. CONCLUSIONS: The most recent data suggest that the proportion of young doctors who sustain an interest in nephrology through the early postgraduate training years may be lower than among their predecessors. Efforts are needed to reverse the declining trend and increase interest in nephrology.

Retirement ages of senior UK doctors: national surveys of the medical graduates of 1974 and 1977.

OBJECTIVE: To report on retirement ages of two cohorts of senior doctors in the latter stages of their careers. DESIGN: Questionnaires sent in 2014 to all medical graduates of 1974 and 1977. SETTING: UK. PARTICIPANTS: 3695 UK medical graduates. MAIN OUTCOME MEASURES: Retirement status by age at the time of the survey and age at retirement if retired. Planned retirement ages and retirement plans if not retired. RESULTS: Of contactable doctors, 85% responded. 43.7% of all responding doctors had fully retired, 25.9% had 'retired and returned' for some medical work, 18.3% had not retired and were working full-time in medicine, 10.7% had not retired and were working part-time in medicine and 1.4% were either doing non-medical work or did not give details of their employment status. The average actual retirement age (including those who had retired but subsequently returned) was 59.6 years (men 59.9, women 58.9). Psychiatrists (58.3) and general practitioners (GPs) (59.5) retired at a slightly younger age than radiologists (60.4), surgeons (60.1) and hospital specialists (60.0). More GPs (54%) than surgeons (26%) or hospital medical specialists (34%) were fully retired, and there were substantial variations in retirement rates in other specialties. Sixty-three per cent of women GPs were fully retired. CONCLUSIONS: Gender and specialty differences in retirement ages were apparent and are worthy of qualitative study to establish underlying reasons in those specialties where earlier retirement is more common. There is a general societal expectation that people will retire at increasingly elderly ages; but the doctors in this national study retired relatively young.

Career Choices and Career Progression of Junior Doctors in Dermatology: Surveys of UK Medical Graduates.

OBJECTIVE: To report UK-trained doctors' career choices for dermatology, career destinations, and factors influencing career pathways. METHODS: Multicohort multipurpose longitudinal surveys of UK-trained doctors who graduated between 1974 and 2015. RESULTS: In all, 40,412 doctors (58% of graduates) responded in year 1, 31,466 (64%) in year 3, and 24,970 (67%) in year 5. One year after graduation, 1.7% of women and 0.6% of men made dermatology their first choice but by five years after graduation the respective figures were 1.0% and 0.7%. Compared to their predecessors, its popularity fell more substantially from years 1 to 5 among recent graduates (2005-15), particularly for women (from 2.1% in year 1 to 0.8% in year 5) compared with a fall from 0.8% to 0.5% among men. The most important factor influencing dermatology choice was "hours/working conditions": in year one, 69% regarded this as important compared with 31% of those choosing other hospital physician specialties. Only 18% of respondents who chose dermatology at year 1 eventually worked in it; however, almost all practising dermatologists (94%), 10 years after qualifying, had made their future career decision by year 5. CONCLUSION: Dermatology is popular among female UK graduates. Most dermatologists made their career decision late but decisively.

Career specialty choices of UK medical graduates of 2015 compared with earlier cohorts: questionnaire surveys.

OBJECTIVE: To report the career specialty choices of UK medical graduates of 2015 one year after graduation and to compare these with the choices made at the same postgraduate stage by previous cohorts. DESIGN: National survey using online and postal questionnaires. SETTING: UK. PARTICIPANTS: UK-trained medical graduates. MAIN OUTCOME MEASURES: Grouped and individual specialty choices. RESULTS: The response rate was 41.3% (3040/7095). Among the graduates of 2015, general practice (27.8% of first choices) and hospital medical specialties (26.5%) were the most frequent first choices of long-term career. First choices for general practice declined among women from 36.1% for the 2005-2009 cohorts to 33.3% for the 2015 cohort, and among men from 22.4% for the 2005-2009 cohorts to 19.3% for the 2015 cohort. First choices for surgery declined among men (from 29.5% for the 2005-2009 cohorts to 21.7% for the 2015 cohort), but not among women (12.3% for the 2005-2009 cohorts and 12.5% for the 2015 cohort). There was an increase in the percentage of first choices for anaesthesia, psychiatry, radiology and careers outside medicine. Anaesthesia, oncology, paediatrics and radiology increased in popularity over time among men, but not among women. CONCLUSIONS: Career choices for general practice remain low. Other current shortage specialties, apart from radiology and psychiatry, are not showing an increase in the number of doctors who choose them. Large gender differences remain in the choices for some specialties. Further work is needed into the determinants of junior doctors' choices for shortage specialties and those with large gender imbalances.

Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation.

Objective To report the reasons why doctors are considering leaving medicine or the UK. Design Questionnaire survey. Setting UK. Participants Questionnaires were sent three years after graduation to all UK medical graduates of 2008 and 2012. Main outcome measures Comments from doctors about their main reasons for considering leaving medicine or the UK (or both). Results The response rate was 46.2% (5291/11,461). Among the 60% of respondents who were not definitely intent on remaining in UK medicine, 50% were considering working in medicine outside the UK and 10% were considering leaving medicine. Among those considering working in medicine outside the UK, the most commonly cited reasons were to gain wider experience, that things would be 'better' elsewhere and a negative view of the National Health Service and its culture, state and politics. Other reasons included better training or job opportunities, better pay and conditions, family reasons and higher expectations. Three years after graduation, doctors surveyed in 2015 were significantly more likely than doctors surveyed in 2011 to cite factors related to the National Health Service, to pay and conditions, to their expectations and to effects on work-life balance and patient care. Among those considering leaving medicine, the dominant reason for leaving medicine was a negative view of the National Health Service (mentioned by half of those in this group who commented). Three years after graduation, doctors surveyed in 2015 were more likely than doctors surveyed in 2011 to cite this reason, as well as excessive hours and workload, and financial reasons. Conclusions An increasingly negative view is held by many doctors of many aspects of the experience of being a junior doctor in the National Health Service, and the difficulty of delivering high-quality patient care within what many see as an under-funded system. Policy changes designed to encourage more doctors to remain should be motivated by a desire to address these concerns by introducing real improvements to resources, staffing and working conditions.

The characteristics and views of early retirees compared with doctors still in work: views of the UK -medical graduates of 1983 surveyed in 2016.

Questionnaires were used to compare the characteristics and views of early retirees with those of doctors who were still working. Of doctors aged under 60 years, 88% were still working in medicine, 5% were fully retired and 7% were 'returners' (had retired and returned to do work). More women (8%) than men (4%) were fully retired. More GPs (13%) than hospital doctors (8%) had retired: male hospital doctors had a low retirement rate of 5.3%. More working doctors (28%) than fully retired doctors (20%) agreed that there were good prospects for improvement of the NHS in their specialty. More fully retired doctors (67%) and returners (67%) than working doctors (55%) referred to adverse health effects of working as a doctor. Early retirement decisions were motivated by the doctors' views of what is happening in their own specialty and by adverse health effects that they attributed to their work.

Changes needed to medicine in the UK before senior UK-trained doctors, working outside the UK, will return: questionnaire surveys undertaken between 2004 and 2015.

OBJECTIVE: To report the changes to UK medicine which doctors who have emigrated tell us would increase their likelihood of returning to a career in UK medicine. DESIGN: Questionnaire survey. SETTING: UK-trained medical graduates. PARTICIPANTS: Questionnaires were sent 11 years after graduation to 7158 doctors who qualified in 1993 and 1996 in the UK: 4763 questionnaires were returned. Questionnaires were sent 17 and 19 years after graduation to the same cohorts: 4554 questionnaires were returned. MAIN OUTCOME MEASURES: Comments from doctors working abroad about changes needed to UK medicine before they would return. RESULTS: Eleven years after graduation, 290 (6%) of respondents were working in medicine abroad; 277 (6%) were doing so 17/19 years after graduation. Eleven years after graduation, 53% of doctors working abroad indicated that they did not intend to return, and 71% did so 17/19 years after graduation. These respondents reported a number of changes which would need to be made to UK medicine in order to increase the likelihood of them returning. The most frequently mentioned changes cited concerned 'politics/management/funding', 'pay/pension', 'posts/security/opportunities', 'working conditions/hours', and 'factors outside medicine'. CONCLUSIONS: Policy attention to factors including funding, pay, management and particularly the clinical-political interface, working hours, and work-life balance may pay dividends for all, both in terms of persuading some established doctors to return and, perhaps more importantly, encouraging other, younger doctors to believe that the UK and the National Health Service can offer them a satisfying and rewarding career.

UK-trained junior doctors' intentions to work in UK medicine: questionnaire surveys, three years after graduation.

Objective To report on the career intentions, three years after qualification, of 12 national cohorts of UK-trained doctors who qualified between 1974 and 2012, and, specifically, to compare recent UK medical graduates' intentions to work in medicine in the UK with earlier graduates. Design Questionnaire surveys of cohorts of UK medical graduates defined by year of graduation. Setting UK. Participants 30,272 UK medical graduates. Main outcome measures Stated level of intention to pursue a long-term career in medicine in the UK. Results The response rate was 62% (30,272/48,927). We examined responses to the question ' Apart from temporary visits abroad, do you intend to practise medicine in the United Kingdom for the foreseeable future?' Of doctors from UK homes, 90% had specified that they would 'definitely or probably' practise medicine in the UK in the surveys of 1977-1986, 81% in 1996-2011 and 64% in 2015. Those who said that they would probably or definitely not practise medicine in the UK comprised 5% in 1977-1986, 8% in 1996-2011 and 15% in 2015. Most who were not definite about a future career in UK medicine indicated that they would wish to practise medicine outside the UK rather than to leave medicine. Conclusions The wish to remain in UK medical practice in the 2015 survey was unprecedentedly low in this unique series of 40 years of surveys.

Factors influencing the decisions of senior UK doctors to retire or remain in medicine: national surveys of the UK-trained medical graduates of 1974 and 1977.

OBJECTIVE: To report attitudes to retirement of late-career doctors. DESIGN: Questionnaires sent in 2014 to all UK medical graduates of 1974 and 1977. SETTING: United Kingdom. PARTICIPANTS: 3695 medical graduates. MAIN OUTCOME MEASURES: Factors which influenced doctors' decisions to retire and factors which encouraged doctors to remain in work. RESULTS: The response rate was 85% (3695/4369). 55% of respondents overall were still working in medicine (whether they had not retired or had retired and returned; 61% of men, 43% of women). Of the retirees, 67% retired when they had originally planned to, and 28% had changed their retirement plans. Fifty per cent of retired doctors cited 'increased time for leisure/other interests' as a reason; 43% cited 'pressure of work'. Women (21%) were more likely than men (11%) to retire for family reasons. Women (27%) were more likely than men (9%) to retire because of the retirement of their spouse. General practitioners (GPs) were more likely than doctors in other specialties to cite 'pressure of work'. Anaesthetists and GPs were more likely than doctors in other specialties to cite the 'possibility of deteriorating skill/competence'. Radiologists, surgeons, obstetricians and gynaecologists, and anaesthetists were most likely to cite 'not wanting to do out-of-hours work'.Doctors who were still working were asked what would encourage them to stay in medicine for longer. Factors cited most frequently were 'reduced impact of work-related bureaucracy' (cited by 45%) and 'workload reduction/shorter hours' (42%). Men (30%) were more motivated than women (20%) by 'financial incentivisation'. Surgeons were most motivated by 'reduction of on-call or emergency commitments'. CONCLUSIONS: Retention policy should address ways of optimising the clinical contribution of senior doctors while offering reduced workloads in the areas of bureaucracy and working hours, particularly in respect of emergency commitments.

Combining parenthood with a medical career: questionnaire survey of the UK medical graduates of 2002 covering some influences and experiences.

OBJECTIVES: To report the self-assessed views of a cohort of medical graduates about the impact of having (or wanting to have) children on their specialty choice and the extent to which their employer was supportive of doctors with children. SETTING: United Kingdom (UK). PARTICIPANTS: UK medical graduates of 2002 surveyed by post and email in 2014. RESULTS: The response rate was 64.2% (2057/3205). Most respondents were living with a spouse or partner (86%) and, of these, 49% had a medical spouse. Having children, or wanting to have children, had influenced specialty choice for 47% of respondents; for 56% of doctors with children and 29% of doctors without children; for 59% of women and 28% of men; and for 78% of general practitioners compared with 27% of hospital doctors and 18% of surgeons. 42% of respondents regarded the National Health Service as a family-friendly employer, and 64% regarded their specialty as family-friendly. More general practitioners (78%) than doctors in hospital specialties (56%) regarded their specialty as family-friendly, while only 32% of surgeons did so.Of those who had taken maternity/paternity/adoption leave, 49% rated the level of support they had received in doing so as excellent/good, 32% said it was acceptable and 18% said the support had been poor/very poor. CONCLUSIONS: Having children is a major influence when considering specialty choice for many doctors, especially women and general practitioners. Surgeons are least influenced in their career choice by the prospect of parenthood. Almost half of doctors in hospital specialties regard their specialty as family-friendly.

The clinical academic workforce of the future: a cross-sectional study of factors influencing career decision-making among clinical PhD students at two research-intensive UK universities.

OBJECTIVES: To examine clinical doctoral students' demographic and training characteristics, career intentions, career preparedness and what influences them as they plan their future careers. DESIGN AND SETTING: Online cross-sectional census surveys at two research-intensive medical schools in England in 2015-2016. PARTICIPANTS: All medically qualified PhD students (N=523) enrolled at the University of Oxford and University College London were invited to participate. We report on data from 320 participants (54% male and 44% female), who were representative by gender of the invited population. MAIN OUTCOME MEASURES: Career intentions. RESULTS: Respondents were mainly in specialty training, including close to training completion (25%, n=80), and 18% (n=57) had completed training. Half (50%, n=159) intended to pursue a clinical academic career (CAC) and 62% (n=198) were at least moderately likely to seek a clinical lectureship (CL). However, 51% (n=163) had little or no knowledge about CL posts. Those wanting a CAC tended to have the most predoctoral medical research experience (χ2 (2, N=305)=22.19, p=0.0005). Key reasons cited for not pursuing a CAC were the small number of senior academic appointments available, the difficulty of obtaining research grants and work-life balance. CONCLUSIONS: Findings suggest that urging predoctoral clinicians to gain varied research experience while ensuring availability of opportunities, and introducing more flexible recruitment criteria for CL appointments, would foster CACs. As CL posts are often only open to those still in training, the many postdoctoral clinicians who have completed training, or nearly done so, do not currently gain the opportunity the post offers to develop as independent researchers. Better opportunities should be accompanied by enhanced career support for clinical doctoral students (eg, to increase knowledge of CLs). Finally, ways to increase the number of senior clinical academic appointments should be explored since their lack seems to significantly influence career decisions.

Aspirations to become an anaesthetist: longitudinal study of historical trends and trajectories of UK-qualified doctors' early career choices and of factors that have influenced their choices.

BACKGROUND: It is important to inform medical educators and workforce planners in Anaesthesia about early career choices for the specialty, factors that influence them and to elucidate how recent choices of men and women doctors relate to the overall historical trends in the specialty's popularity. METHODS: We analysed longitudinal data on career choice, based on self-completed questionnaires, from national year-of-qualification cohorts of UK-trained doctors from 1974 to 2012 surveyed one, three and 5 years post-qualification. Career destination data 10 years post-qualification were used for qualifiers between 1993 and 2002, to investigate the association between early choice and later destinations. RESULTS: In years 1, 3 and 5 post-qualification, respectively, 59.9% (37,385), 64.6% (31,473), and 67.2% (24,971) of contactable doctors responded. There was an overall increase, from the early to the later cohorts, in the percentage of medical graduates who wished to enter anaesthesia: for instance year 1 choices rose from 4.6 to 9.4%, comparing the 1974 and 2012 cohorts. Men were more likely than women to express an early preference for a career in anaesthesia: for example, at year 3 after qualification anaesthesia was the choice of 10.1% of men and 7.9% of women. There was a striking increase in the certainty with which women chose anaesthesia as their future career specialty in recent compared to earlier cohorts, not reflected in any trends observed in men choosing anaesthesia. Sixty percent of doctors who were anaesthetists, 10 years after qualifying, had specified anaesthesia as their preferred specialty when surveyed in year 1, 80% in year 3, and 92% in year 5. Doctors working as anaesthetists were less likely than those working in other hospital specialties to have specified, as strong influences on specialty choice, 'experience of the subject' as students, 'inclinations before medical school', and 'what I really want to do'. Men anaesthetists were more influenced in their specialty choice than men in other hospital specialties by 'wanting a career with acceptable hours'; the corresponding difference among women was not significant. CONCLUSIONS: We suggest a focus on inspirational teaching of anaesthesia in medical school and on greater exposure to the specialty in the foundation programme. Factors which may discourage women from entering anaesthesia should be explored and addressed.

Adverse effects on health and wellbeing of working as a doctor: views of the UK medical graduates of 1974 and 1977 surveyed in 2014.

Objective To report on any adverse effects on health and wellbeing of working as a doctor, as described by senior doctors. Design Questionnaires sent in 2014 to all medical graduates of 1974 and 1977. Participants 3695 UK medical graduates. Setting United Kingdom. Main outcome measures Statements about adverse effects upon health, wellbeing and career. Results The aggregated response rate from contactable doctors was 84.6% (3695/4369). In response to the question 'Do you feel that working as a doctor has had any adverse effects on your own health or wellbeing?', 44% of doctors answered 'yes'. More GPs (47%) than hospital doctors (42%) specified that this was the case. Three-quarters of doctors who answered 'yes' cited 'stress/work-life balance/workload' as an adverse effect, and 45% mentioned illness. In response to the statement 'The NHS of today is a good employer when doctors become ill themselves', 28% of doctors agreed, 29% neither agreed nor disagreed and 43% disagreed. More women doctors (49%) than men doctors (40%) disagreed with this statement. More general practitioners (49%) disagreed than hospital doctors (37%). Conclusions Chronic stress and illness, which these doctors attributed to their work, were widely reported. Although recent changes may have alleviated some of these issues, there are lessons for the present and future if the NHS is to ensure that its medical workforce receives the support which enables current doctors to enjoy a full and satisfying career and to contribute fully to health service provision in the UK. Older doctors, in particular, need support to be able to continue successfully in their careers.

Adequacy of postgraduate medical training: views of different generations of UK-trained doctors.

BACKGROUND: Over the last decade, many changes have taken place in the UK, which have affected the training that doctors receive. AIM: To assess doctors' views on quality and adequacy of postgraduate training. METHODS: Questionnaires about training sent to UK-trained doctors who graduated between 1974 and 2012. RESULTS: Among trainees towards the end of their first year of medical work and training, 36% agreed that in their first year "Training was of a high standard"; 21% disagreed; 43% neither agreed nor disagreed. Only 16% agreed "I had to perform clinical tasks for which I felt inadequately trained".Among doctors 12 years into their careers, 83% agreed "My training has been long enough, and good enough, to enable me to practise adequately when I first become/became a consultant or GP".Among senior hospital doctors aged in their 50s or 60s, 21% agreed that "These days, the training of specialist doctors in the NHS is sufficient to enable them to practise adequately when they first become consultants"; 38% disagreed, and the rest neither agreed nor disagreed. Of senior GPs, 41% agreed "These days, the training of GP trainees in the NHS is sufficient to enable them to practise adequately when they first become GPs"; 28% disagreed. CONCLUSIONS: Views on early career training were mixed, but few felt exposed to clinical situations beyond their ability. Most newly appointed consultants and GPs felt adequately trained for practice, though many senior doctors were unsure that this was the case.

Trends in attractiveness of general practice as a career: surveys of views of UK-trained doctors.

BACKGROUND: It is current UK policy to expand the numbers of newly qualified doctors entering training to become GPs, to meet increased demand. AIM: To report on trends in young doctors' views on the attractiveness of general practice as a career, compared with hospital practice. DESIGN AND SETTING: Questionnaire surveys in the UK. METHOD: Surveys of doctors, 3 years after graduation, conducted in successive year-of-qualification cohorts between 1999 and 2015. RESULTS: The overall response rate from contactable doctors was 55%. In response to the statement 'General practice is more attractive than hospital practice for doctors at present', 59% of doctors agreed in the 1999 survey, 77% in 2005, and only 36% in 2015. One-third of doctors agreed that their exposure to general practice had been insufficient for them to assess it as a career option, but this improved over time: agreement fell from 39% in 1999 to 28% in 2015. As a factor influencing specialty choice, enthusiasm for, and commitment to, the specialty was rated as very important by 65% of intending GPs in 2015, up from 49% in 1999; the corresponding figures for intending hospital doctors were 91% in 2015, up from 61% in 1999. CONCLUSION: Over the 16 years covered by this study, the attractiveness of general practice has fallen relative to hospital practice. This may not necessarily reflect a decline in attractiveness of general practice in absolute terms; rather, it may reflect a greater increase, over time, in the appeal of hospital practice.