PREFERENCES, EXPECTATIONS AND CAREER CHOICES: A BEST WORST SCALING STUDY OF JUNIOR DOCTORS' CHOICE OF SPECIALISM IN ENGLAND

Purpose:

We investigate the job attributes that:

·        medical trainees most value in their future specialism

·        medical trainees most associate with a career in General Practice.

Combining these we investigate the crisis in General Practice in the UK which is characterised by high levels of exit accompanied by insufficient recruitment.

  Method(s):

We identify 36 job attributes and use BWS to elicit (i) the relative importance of those attributes to trainees, and (ii) the extent to which they (dis)associate the attributes with a career as a GP.

The data are analysed by estimation of heteroscedastic conditional logit and scale adjusted latent class models. Logit models are estimated to identify the factors (BWS importance scores, demographics, attitudes etc) which affect trainees' choice of specialism.

  Result(s):

From our sample of over 800 trainees, only 20% reported that GP was there first of specialism. Choice models estimated on the career desirability BWS indicate that a good work-life balance, working as part of a team and having control over where one works things are among the most desirable job traits. The opportunity to manage a clinical service and working in a speciality to which entry is competitive were among the least desirable.

A good work-life balance was more than twice as important as recognition or job security, more than 5 times as important as being involved in research and more than 7 times as important as having a good chance of promotion.

We find no significant correlation between the desirability of job traits and the degree to which they are associated with a career as a GP.  Plotting BWS Importance Scores against each other (Figure 1) highlights inconsistencies between what trainees seek in their medical career and their expectation of GP.

Undesirable job attributes which were strongly associated with a career as a GP included working in a community-based role and working alone.  Excitement was a strongly desired attribute but was not associated with a GP career.

  Conclusion(s):

Choice models allow marginal effects to be derived showing the impact of variations in job attribute importance on the likelihood of applying for General Practice.

The results suggest that substantial changes to the (perceived) attributes of a General Practice role are required to increase the proportion of trainees choosing this specialty.