Department of Family Medicine, Clalit Health Services ± Haifa and Western ... Key words: medical specialty choice, women in medicine, generalist career choice ...
Educational Notes Trends in Medical Specialty Choice Among Israeli Medical Graduates, 1980±1995
Shmuel1 Reis MD1, Margalit Goldfracht MD1, Ada Tamir DSc2, Riki Van Raalte MA1, Tomas Spenser 1 FRCGP and Doron Hermoni MD Department of Family Medicine, Clalit Health Services ± Haifa and Western Galilee District and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel 2 Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel 1
Key words: medical specialty choice, women in medicine, generalist career choice, medical education in Israel, medical personnel planning
states: ` There are clear signs that the role of the medical as the main force in determining the medical career Which medical specialties do Israeli medical profession structure will come under increasing pressure if senior members graduates choose? Answers to this question can serve as an of the profession fail to recognize the need for fundamental essential means of evaluating both Israeli medical education changes in the system of training, supporting and maximizing and the healthcare system. the talents of all its members.' ' This statement underscores the To determine the distribution of medical relevance of MSC data and analysis for policy makers, specialty choice, its change over time and the possible educators and academics but also fornottheonlyfuture and indepeninfluence of the medical school on the choice; to study the dence of the medical profession at large. graduates' gender, gender variability in specialty choice and the last decade, due to the negative impact of geographic time trends in both; and to assess the choice of family andInprofessional specialty maldistribution on healthcare quality medicine as a career among the graduates as a group, by and equity, the MSC issue has become an important determimedical school, gender, and time trends. nant of the health status of individuals, communities and The study population comprised all graduates of nations [5±7]. The relationship between specialty distribution the four medical schools in Israel during 16 years: 1980±1995 and the performance of a healthcare system is now largely inclusive. Data were obtained from the four medical schools, accepted. Starfield [7] pioneered the documentation primary the Israel Medical Association's Scientific Council, and the care impact as a determinant of a nation's health ofstatus. Ministry of Health. Data allowed for correct identification of some countries (the United States in particular), primary careIn two-thirds of the graduates. enhancement is a national goal and a means to address A total of 4,578 physicians graduated during this career the noxious effects of specialty maldistribution [5±9]. period. There was a significant growth trend in the proportion Other MSC such as future attrition, gender [10±12], of women graduates from 22.6% in 1980 (lowest: 20.0% in medical schoolaspects experience and more [1,13] are referred to in the 1981) to 35.3 in 1995 (highest: 41.5% in 1991). Overall, 3,063 literature with increasing frequency. Surprisingly, Israel has only physicians (66.8%) started residency and 1,714 (37.4%) sparse data on MSC [14]. For a country that not only has one of became specialists. The four most popular residencies were the world's highest per capita physician [15], but in internal medicine, pediatrics, obstetrics and gynecology, and addition has been experiencing a healthcareratios crisis for a family medicine. Ten percent of Israeli graduates choose decade, one might have expected a close scrutiny of attheleast MSC family medicine. ± however this is not the case [14]. The potential The overall class size in Israel was stable at issue relationship this crisis and specialty maldistribution, a time of considerable population change. Women's place in dominance ofbetween hospital-based and overproduction of Israeli medicine is undergoing significant change. Family manpower (which generatesspecialties costs with, at best, marginal medicine is one of the four most popular residencies. A contribution to the nation's health) have been examined only monitoring system for MSC in Israel is imperative. on a small scale [14,15]. We have embarked on the present study with this perspective in mind. Our aim was to collect data on the MSC of medical school graduates in Israel in order to inform the various interested parties, as well as the professional Medical specialty choice is an issue for many. Policymakers and public debate. perceive MSC as part of medical workforce planning, educators view it as an outcome of their efforts, and academics strive to Study scope build an MSC theory [1±4] . In a fascinating article [1], Allen Our study aimed to identify the trends in specialization choices among the graduates of the four medical schools in Israel MSC = medical specialty choice Abstract
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IMAJ 2001;3:973±977
IMAJ
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Vol 3
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December 2001
Specialty Choice of Israeli Medical School Graduates
973
Educational Notes
during the 16 years between 1980 and 1995. The main research objectives were: . to paint an overall picture of medical graduates during their study years . to determine the distribution of specialty choice among Israeli medical school graduates (as a whole and by school of graduation) . to describe the changes over time in the distribution of specialties by comparing 1980±87 to 1988±95 . to describe the graduates' gender, gender variability in specialty choice, and time trends in both . to discuss the choice of family medicine as a career among the graduates as a group by medical school, gender, and time trends.
trends data were aggregated into two equal periods, 1980±87 and 1988±95 respectively, for ease and clarity of presentation. Results Gr ad ua tes '
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c h ara cte r is tics
Numbers and changes over time in the four medical schools [Table 1]
A total of 4,578 physicians graduated from Israeli medical schools during the years 1980±1995. There was no significant change in the overall number of graduates during this period. The balance between the schools changed significantly over time: the number of Haifa medical school graduates grew by 18% in the second time period (1988±95), and the proportion of those in the total class in the Jerusalem and Tel Aviv medical schools diminished by about 8% each. In each year during the Methods 1980±1995 time period, about 300 physicians graduated from The study population comprised all the graduates of the four the four medical schools. faculties of medicine (Hebrew University-Hadassah in Jerusa- . lem, Sackler Faculty of Medicine in Tel Aviv, Rappoport Faculty Of the 4,578 graduates 3,193 (69.7%) were men. During the of Medicine at the Technion in Haifa, and Faculty of Health 1980±87 period 1,718 men (74.2%) and 598 women (25.8%) Sciences at Ben-Gurion University in Beer Sheva) during 16 graduated, compared to 1,475 (65.2%) and 787 (34.8%) years, 1980±1995 inclusive. Specialty training in Israel takes respectively during the 1988±95 period. There was a significant from 4 to 6 years, with some overlap. Thus, graduates of the growth in the proportion of women graduates (
