Many factors affect the career choices of graduating medical school students. Influences such as strong mentors, formative academic and nonacademic experiences, and career counseling can all help aspiring physicians select their particular careers. Similarly, market trends, self-perception of strengths and weaknesses, and anticipated lifestyle can also affect career choice.
The Association of American Medical Colleges (AAMC) and its member schools follow students' career intentions with the data obtained from the annual Medical School Graduation Questionnaire (GQ). These analyses may include review of current data, special topic evaluation, and trend analysis. Review of recent data informs the faculty and administration of current issues in medical education and facilitates appropriate action. Special topic evaluation can be employed for areas of GQ focus, such as student specialty choice. Trend analysis of multiple years of data can identify positive and negative trends at their medical school and nationwide. Trends in career preferences, for example, have been tracked for many years on the GQ.
This article investigates some of the trends in student career preferences that have emerged during the last decade based on responses to a question on the GQ that asks students to indicate their career intentions (academic teaching and research, clinical practice, or "other"). Patterns of responses in 1990, 1995, and 2000 were examined. Students' responses to the "other" option were also studied for a more detailed understanding of student plans in the area of nontraditional careers.
The GQ is a national questionnaire that has been administered in the spring of each year to graduating US medical students since 1978.1 The 2000 version of the GQ was Web-based and included more than 250 items covering a wide variety of topics, including educational experiences, student debt, and career plans. The data can be aggregated for each school as well as nationally.
The GQ data used for this report come from a question in which respondents were asked to indicate their career intentions and were given choices among various career types within academic medicine, clinical practice, and other careers. This study focuses on the data collected for the years 1990, 1995, and 2000. During the 10-year period slight changes were made to the options in this question, including the addition of an "undecided" option in 1997. The data for 2000 were adjusted for changes in data collection and reporting to make 2000 data more closely match the data from 1990 and 1995. Specifically, an adjusted n = 12 423 was used in the 2000 calculations. This adjusted n was obtained by extracting the "undecided" responses ("undecided" was not an option in 1990 or 1995) and adding the 479 nonresponses for this particular question.
The 2000 GQ had 14 416 responses or a 90% response rate. There were 13 336 responses to the 1995 GQ (a response rate of 83.9%), and 11 617 responses on the 1990 GQ, for a response rate of 75.4%.
Figure 1 presents self-reported career intentions in 1990, 1995, and 2000. The 2000 GQ data indicate that more than half of graduating medical students (56.9%) intend to pursue full-time nonacademic clinical practice, 31.0% plan to become full-time university faculty, and 8.4% of medical students are intending other career options.
Career Intentions of US Medical Students at Graduation
In examining trends in career intentions during the past 10 years, the percentage of students who indicated their intention to become full-time university faculty has remained relatively constant; 30.1% indicated academic career intentions in 1990, 29.1% in 1995, and 31.0% did so in 2000. However, the percentage of those who planned to go into clinical practice decreased from 64.6% in 1990, to 62.7% in 1995, to 56.9% in 2000, while the number of students who selected the "other" option nearly doubled during the decade, rising from 4.4% in 1990, to 5.7% in 1995, and to 8.4% in 2000.
In 2000 there were 1 045 students who indicated "other" career plans on the GQ. Of these, 585 (4.7% of total respondents) intend to work for a state or federal agency, such as the Department of Veterans Affairs, the armed forces, or a public health service. Seventy (0.6% of total) intended to pursue careers in medical/health care administration (without practice), and 42 (0.3% of total) planned to be non-university research scientists. Yet another 348 (2.8% of total) indicated that they would prefer to pursue other, unspecified career tracks (Figure 2). The number in the unspecified group increased slightly between 1990 and 2000, rising from 129 (1.1%) in 1990, to 169 (1.3%) in 1995, to 348 (2.8%) in 2000. The number of those who identified an intention to work at a state or federal agency also increased during the 10 year period, rising from 307 (2.6%) in 1990, to 474 (3.6%) in 1995, to 585 (4.7%) in 2000.
Career Intentions of US Medical Students Who Plan to Pursue Nonclinical Careers
Additional data from the GQ also indicate that other students intend to pursue additional academic degrees, with a trend for students to choose a combined field of study in addition to their MD degree. In 1990, 2.7% of the students indicated that they had pursued a combined degree (master's/MD, MD/PhD, or MD/JD), while in 1995, 2.8% of graduating medical students indicated that they had pursued combined degrees. Since 1996, however, there has been a slow but steady increase in the percentage of students choosing combined degrees: 3.4% in both 1997 and 1998, 3.7% in 1999, and 4.5% in 2000. While these results are not dramatic, they do show some slight changes in students' career plans.
The GQ data indicate a slight decrease in the percent of students who intend to pursue traditional career tracks and a growing number of students who intend to enter non-traditional fields. While the reasons behind this growth are not directly assessed in the GQ, these trends could be results from, among other influences, the impact of managed care on the practice of medicine, or the overall diversification of the US economy and the resulting interest in other career alternatives. For instance there is an increasing demand for physicians in the pharmaceutical and medical supply industries, bioengineering, health care management, consulting, medical journalism, and public health.2- 6 While the GQ assesses major categories of alternative career plans (non-university research, federal/state government, medical/health care administration, and public health), it would be useful to study this subgroup in more detail.
The GQ data regarding career intentions are useful in assessing changes in student preference and perception of the job market. These data, which assess intention, should be analyzed in conjunction with career choice data at the end of residency or after some time in the work force. While the GQ can reveal general trends, more detailed research in the area of alternative career paths is needed. Organized data collection efforts should be conducted so that career counselors can better assist students interested in these opportunities. Future research might include following up with students who intended to pursue alternative career paths to determine their actual career choice, conducting a more thorough investigation of the alternative career paths currently being followed, and examining the reasons for changes in the career paths being selected by some of our graduating physicians. Clearly many possibilities for research exist, and the data indicate a trend in the direction of more nontraditional medical career paths. Further examination is needed to determine how this trend will affect the available workforce, the educational process, and the future of health care provision.
Richard GV, Nakamoto DM, Lockwood JH. Medical Career Choices: Traditional and New Possibilities. JAMA. 2001;285(17):2249-2250. doi:10.1001/jama.285.17.2249-JMS0502-3-1