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December 10, 2003

Lifestyle as a Factor in Medical Students' Career ChoicesLifestyle as a Factor in Medical Students' Career Choices

JAMA. 2003;290(22):2940-2942. doi:10.1001/jama.290.22.2940-a

To the Editor: Dr Dorsey and colleagues1 concluded that "controllable lifestyle" explains the majority of the variance in specialty choices of graduating US medical students since1996. However, the data indicate that controllable lifestyle was primarily found in well-paid specialties, and therefore uncontrolled factors such as increasing medical student debt loads may have explained much of this effect. The largest proportional increases in medical student applicants were seen in anesthesia (481.8%) and dermatology (1050.0%). Historic trends unrelated to controllable lifestyle may account for a significant portion of these changes. Medical student interest in anesthesiology decreased significantly shortly before the baseline year, 1996. A 1995 front-page Wall Street Journal article chronicled the shortage of anesthesiology jobs, which may have influenced medical students to avoid the specialty.2 The significant upward trend in interest in anesthesiology after 1996 may simply reflect recovery from this nadir.3 The authors noted that only 33 students nationwide were recorded as listing dermatology as their first choice in 1996, which would exaggerate the apparent subsequent upward trend in applications, but the authors did not appear to have tested the robustness of their results to excluding these data.