DOI:10.2214/AJR.06.0539
AJR 2007; 188:897-900
© American Roentgen Ray Society
Choosing a Specialty in Medicine: Female Medical Students and Radiology
Julia R. Fielding1,
Nancy M. Major2,
Brian F. Mullan3,
Janet A. Neutze4,
Kitt Shaffer5,6,
Claire B. Wilcox1,
Lauren Paynter7 and
Etta D. Pisano1
1 Department of Radiology, University of North Carolina at Chapel Hill, 101
Manning Dr., Campus Box 7510, Chapel Hill, NC 27599.
2 Department of Radiology, Duke University Medical Center, Durham, NC.
3 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City,
IA.
4 Department of Radiology, Pennsylvania State University, Hershey, PA.
5 Department of Radiology, Harvard University, Boston, MA.
6 Present address: Department of Radiology, Cambridge Hospital, Cambridge,
MA.
7 Department of Biostatistics, School of Public Health, University of North
Carolina at Chapel Hill, Chapel Hill, NC.
Received April 19, 2006;
accepted after revision September 12, 2006.
Address correspondence to J. R. Fielding
(julia_fielding{at}med.unc.edu).
FOR YOUR INFORMATION
Mark your calendar for the following ARRS annual meetings: May 6-11,
2007—Grande Lakes Resort, Orlando, FL; April 13-18, 2008—Marriott
Wardman Park Hotel, Washington, DC.
Abstract
OBJECTIVE. The purpose of this study was to determine whether there
are identifiable factors that dissuade female medical students from entering
the field of radiology.
MATERIALS AND METHODS. An anonymous survey was completed by medical
students at the end of their third- or fourth-year radiology clinical
clerkships at five institutions. In addition to demographic data and residency
choice, respondents ranked 10 factors in order of importance to their choice
of career. For respondents who did not consider radiology a possible career, a
second set of eight factors was ranked for importance in dissuading them.
RESULTS. Two hundred eighty-eight respondents completed the survey,
152 (53%) men and 136 (47%) women. Both men and women reported direct patient
contact and intellectual stimulation as the most important factors in deciding
on a specialty. For those who chose radiology, intellectual stimulation and
use of emerging technology were significantly (p < 0.05) more
important than other factors. The factor that most strongly (96%) dissuaded
men and women from a career in radiology was lack of direct patient contact.
There was no significant difference between men and women in ranking factors
that dissuaded them from applying to radiology residencies; however, nearly
one third of the female respondents cited competitiveness of the residency
process as important.
CONCLUSION. Patient contact remains an important factor for medical
students choosing a career. To attract high-caliber students, medical schools
should expose students to areas of radiology involving patient interaction.
Academically qualified women should be identified early during their careers
and encouraged to apply for radiology residencies.
Keywords: education • radiology education • radiology practice
Introduction
The number of women choosing diagnostic radiology as a career has
been declining. In 1995, 14% of all practicing radiologists in the United
States were women and 28% of radiology residents were women
[1]. In 2000, the percentage of
practicing radiologists who were women increased slightly to 16%, but the
percentage of radiology residents who were women declined to 22%
[2]. During this same period,
the number of female medical students increased to the extent that women made
up approximately one half of every medical school class
[3]. Because the often stable
work hours of radiology in comparison with other medical disciplines would
seem likely to appeal to women, the decrease in the number of female
applicants is difficult to explain. The goal of our project was to define the
factors most important to medical students in choosing or rejecting a career
and to analyze these data to determine why women are not choosing
radiology.
Materials and Methods
After discussions with colleagues and medical students at one institution,
we developed a questionnaire designed to determine the social factors most
important to medical students choosing a career. To capture the largest number
of students interested in radiology, the survey was administered to third- and
fourth-year students at the completion of their medical school radiology
clerkships at five medical schools. Because the survey was anonymous and
optional and had no connection to final grading, the study was exempt from
institutional review board approval at the participating institutions. Four of
the medical schools offered radiology as an elective clinical rotation, and
one required participation by all students.
After providing demographic data such as sex, race, and age, all students
were asked to rank 10 factors important in choosing a medical specialty. These
10 factors were salary, work hours, job flexibility, intellectual stimulation,
use of emerging technology, contact with patients and effect on their lives,
perception of specialty by mentors and colleagues, perceived job satisfaction
among those in the specialty, job opportunities available, and competitiveness
of the residency selection process. Respondents were then asked whether they
had chosen a residency specialty and, if so, the field.
All students were asked whether they would consider radiology as a career.
The students who responded that they would not were asked to complete a second
portion of the survey, ranking eight factors that dissuaded them from
considering radiology, again in order of importance to them. These factors
were requirement of physics and technical expertise, role as a consultant to
other physicians, lack of direct patient contact, potential exposure to
radiation, negative perception of radiology by mentors and colleagues,
perceived lack of job satisfaction among radiologists, perceived lack of job
flexibility, and competitiveness of obtaining a residency in radiology.
A factor was considered important to a respondent when it was ranked as one
of the three most important factors. In this way variables were characterized
as either important or not important, yielding dichotomous data. In many
cases, students did not rank all variables. Blanks were considered not
important to the respondent. For each factor, the number of medical students
classifying it as important and the corresponding percentages were determined
for descriptive purposes for men and women among students choosing radiology
as a specialty and those not choosing radiology as a specialty. Comparisons
between the two groups were made for each factor with Mantel-Haenszel tests
adjusted for sex. Comparisons were then made between the two sexes for each
factor, again with Mantel-Haenszel tests, this time adjusted for whether
radiology was the chosen specialty.
Results
Four hundred sixteen students were given the survey, and 288 completed it,
yielding a response rate of 69%. One hundred thirteen students in this group
were participating in a required radiology clinical clerkship, and the others
had chosen the clerkship as an elective rotation. One hundred fifty-two of the
respondents were men (53%) and 136 were women (47%). Of this group, 230 (80%)
of the students had chosen a specialty, and 58 (20%) had not. This
distribution corresponded closely to that of the fourth-year (n =
206) and third-year (n = 81) students. One student did not provide
year in medical school. The average age of a respondent was 27 years with a
range of 22-50 years. Complete demographic data are reported in
Table 1. Across the five
medical schools, the percentage of medical students who were women ranged from
49% to 51%.
View this table:
[in this window]
[in a new window]
|
TABLE 1: Demographic Data on 288 Medical Students Responding to Career Choice
Survey (mean age, 27 years; age range 22-50 years)
|
|
For students who had chosen a medical specialty, the most common
specialties were internal medicine (n = 42, 18%), radiology
(n =35, 15%), and family practice (n = 24, 10%). The other
commonly chosen specialties are listed in
Table 2. Factors considered
most important in career choice were the same for men and women. In order of
importance, these factors were direct patient contact, intellectual
stimulation, and perceived job satisfaction of physicians in the specialty
(Table 3). For both men and
women who had chosen radiology as a career, intellectual stimulation
(p =0.004) and use of emerging technology (p = 0.0001) were
more important than they were for the group who had not chosen radiology as a
career. Women who had chosen a radiology career put less importance on salary
(p = 0.005) and more importance on direct patient contact (p
=0.02) than did men who had chosen radiology.
For those who had not considered radiology as a career (n = 169),
lack of patient contact was the most important factor (p = 0.0001)
followed by role as a consultant rather than primary care physician. For
women, the third most important factor was competitiveness of the residency
selection process, whereas for men it was the physics requirement. These
results are reported in Table
4. The only significant difference identified between men and
women who had not considered radiology as a career was that men considered job
flexibility more important (p = 0.01). Men also tended to consider a
role as a consulting physician more negatively (p =0.05).
Discussion
Our survey results show that medical students consider direct patient
contact and intellectual stimulation the most important factors in deciding on
a career. For both men and women, a perceived lack of patient contact and role
as consultant physician were cited as the most undesirable parts of radiology
and influenced students not to enter the specialty. No significant differences
were identified to explain why women do not choose radiology but men do.
However, competition for a residency position was cited as important by nearly
one third of women who responded, compared with one fifth of men. Few students
of either sex reported possible radiation exposure as a factor in their
decision.
There are few published data on female medical students' perspectives on
factors that influence residency choice. In a 1990 study involving 346 medical
students from nine U.S. medical schools, Schwartz et al.
[4] found that students were
most inclined to select careers that had fewer numbers of practice work hours
per week, allowed adequate time for pursuit of recreational activities, and
seemed to have a smaller number of on-call nights. These factors were more
important than prestige, salary, or years of postgraduate training. Job
flexibility was reported by a minority of our respondents as important in
deciding on a career. In 2003, Dorsey et al.
[5] reported survey results
obtained from a large group of matriculating medical students. Those authors
found that a controllable lifestyle, including defined time on and off the
job, accounted for the increased number of applicants to radiology and
anesthesiology residencies. In neither of the studies was the sex of the
applicants specifically addressed.
In 2003, the most popular specialties among 58,138 male resident physicians
on duty in programs accredited by the Accreditation Council for Graduate
Medical Education were internal medicine (21.8%), general surgery (9.9%), and
family medicine (8.1%) [6]. For
39,947 female resident physicians, the corresponding specialties were internal
medicine (22.0%), pediatrics (13.3%), and family medicine (12.2%)
[6]. There were 4,044 radiology
residents, and 26.8% members of that group were women. Compared with 1993
[7], in 2003 more women worked
as residents in family medicine, internal medicine, and general surgery; fewer
women were working in anesthesiology and pathology; and there were fewer
radiology residents of either sex. These facts correlate with the results of
our survey. Both male and female medical students gravitate to specialties in
which a considerable amount of direct patient care is provided.
A potential limitation of this study was population bias. Because more than
50% of the sample was taken from the cohort of medical students who had taken
an elective radiology clerkship, it is likely that opinions of students who
had never considered radiology were underrepresented in our results. Important
factors in dissuading a student from a career in radiology may have been
overlooked. We believed it important, however, to maximize data obtained from
potential radiologists. In retrospect, both portions of the survey probably
should have included years of postgraduate training as a factor in deciding on
specialty training, particularly because of the debt load many students carry.
This factor was not included because it was not mentioned in any of the
informal discussions with medical students and colleagues that were used to
devise the survey. Years of postgraduate training also are unlikely to be an
important factor for many medical students, because during the past decade,
applications for 5-year residency positions in general surgery have increased
[3].
Because both men and women cited perceived lack of patient contact as the
most important factor in not choosing radiology as a career, early exposure to
radiologists who work with patients every day, including interventionalists,
mammographers, and pediatric specialists should be encouraged. It also may be
time to change the emphasis from patient contact to patient impact. It is a
rare patient who does not undergo an imaging examination for diagnosis. During
all ward rotations, the importance of radiology to accuracy and efficiency of
patient care should be emphasized.
The reality is that radiology is a competitive specialty. Hundreds of
applications are received for the few coveted training positions offered each
year. Results of recent studies
[8] suggest that women are more
likely than men to eschew competitive situations. Still, there is no reason
that women should be any less competitive than men for the available
positions. Mentors counseling women to consider radiology as a specialty
should help qualified candidates to overcome their reservations about risk of
failure. Both staff and residents should be encouraged to discuss the field
with female medical students to emphasize that radiology is an attainable and
satisfying career.
References
- Deitch CH, Sunshine JH, Chan WC, et al. Women in the radiology
profession: data from a 1995 national survey. AJR1998; 170:263
-270[Abstract/Free Full Text]
- Sunshine JH, Cypel YS, Schepps B. Diagnostic radiologists in 2000:
basic characteristics, practices and issues related to the radiologist
shortage. AJR 2002;178
: 291-301[Abstract/Free Full Text]
- Association of American Medical Colleges. FACTS: applicants,
matriculants and graduates. Available at:
www.aamc.com/data/facts/start.htm.
Accessed January 16, 2006
- Schwartz RW, Haley JV, Williams C, et al. The controllable
lifestyle factor and students' attitudes about specialty selection.
Acad Med 1990; 65:207
-210[Medline]
- Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable
lifestyle choice on recent trends in specialty choice by US medical students.
JAMA 2003; 290:1173
-1177[Abstract/Free Full Text]
- [No authors listed]. Graduate medical education.
JAMA 2004; 292:1099
-1113[Free Full Text]
- [No authors listed]. Graduate medical education.
JAMA 1994;272:725
-733
- Sax L. Why gender matters: what parents and teachers
should know about the emerging science of sex differences. New
York, NY: Doubleday, 2005:39
-76
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Top
Abstract
Introduction
