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.
Lee BY, Hecht T, Volpp K. 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
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