Background In view of predicted shortages in rheumatology services across Australia (1), efforts need to be made to recruit more junior doctors to the specialty. Understanding Australian basic physician trainees (BPTs) interest levels in pursuing rheumatology training and the factors that influence this decision will be essential in informing strategies to improve recruitment. Overseas studies suggest that exposure, especially during the early stages of training as well as mentorship and subject matter interest are important factors in attracting junior doctors to internal medicine specialties (2,3). To date there have been no similar published data in Australian BPTs.
Objectives To assess the current popularity amongst Australian BPTs of pursuing rheumatology as a career choice and to determine the underlying factors that influence the subspecialty career choice decision.
Methods We performed a cross sectional analysis of BPTs attending a written preparation course at our institution in 2011 and 2012. A self-administered paper-based anonymous questionnaire was distributed to trainees enquiring about their internal medicine subspecialty preference, when this was decided and to what extent the decision was influenced by a set of given criteria (lifestyle, salary expectations, mentors, competitiveness, subject matter interest and procedures, perceived difficulty, and specialty exposure at different levels of training).
Results 253 BPTs completed the survey, with a response rate of 63.3%. The average age of trainees was 29.6 years (range 22-50), 55% were female, 45.1% were post graduate year (PGY) 3 and 31.2% were PGY4. Only 4.5% were planning to pursue rheumatology as a career ranking it ninth out of the twelve internal medical subspecialties. This increased to 23.7% when asked to nominate their top three preferences. Most people made this career decision in the first two postgraduate years (39.5%) or later (41.3%). Regarding exposure, 46.2% of BPTs had not completed a term in rheumatology at any level. Of those who had, 32.4% was as a medical student, 17.4% as a PGY1 or 2, and 9.5% as a registrar. The mean number of weeks spent in rheumatology since graduating from medical school was 8.5 (range1-24) and this positively correlated with those planning to pursue rheumatology as a career (χ2 =59.06, p<0.0005). Factor analysis identified three factors (experience and mentorship, lifestyle, and opportunity to do procedures) influencing trainee specialty choice, accounting for 54.3% of the variance.
Conclusions Rheumatology is not a popular first choice of subspecialty amongst current Australian BPTs, however it is commonly ranked in their top three preferences. Exposure to rheumatology at all levels of training is poor. The factors influencing BPT career choice include exposure, mentorship, lifestyle and the potential to do procedures. Efforts to improve recruitment into rheumatology should take into consideration these factors.
Health Workforce Australia 2012: Health Workforce 2025, Volume 3 – Medical Specialties.
Kolasinski SL, Bass AR, Kane-Wanger GF, et al. Subspecialty Choice: Why Did You Become a Rheumatologist? Arthritis & Rheumatism (Arthritis Care & Research). 2007;57(8):1546-51.
Dunkley L, Filer D, Speden D, Crisp A. Why do we choose rheumatology? Implications for future recruitment-results of the 2006 UK Trainee Survey. Rheumatology. 2008;47:901-06.
Disclosure of Interest None declared