Did you choose them, or did they choose you?

Specialty choice algorithm via @FizzyMcFizz


Medical stereotypes are a well known, ranging from the hippy-esque GP, to the man-mountain of an orthopaedic surgeon, via the suave and sophisticated plastic surgeon.  I’m not entirely sure what the stereotype of a chest physician is, but I would be grateful if you could let me know…

These stereotypes, and perceptions of who goes into which specialty are deep-seated, with some of the negative associations between specialty choice and types of doctor being identified early in medical studies, and seemingly perpetuated by senior staff.  So what makes one choose a particular specialty?  It might be something to do with the types of patients being cared for, the opportunities for research, the work patterns, the remuneration, intensity of on-call, or it may be influenced by our personality.

A study published online recently by the PMJ tried to examine the contribution of personality to specialty choice in doctors working in Sweden.  The paper describes the results of a survey of Swedish medical graduates in 2013.  The Big Five Inventory was used to quantify personality traits, method of entry into medical school was also recorded, along with a number of other questions about lifestyle, economic status, involvement in research and a basic enquiry about the need for mental health treatment within the past 12 months.

The results of the study seemed to confirm the stereotypes of different specialties to a certain degree, with surgeons being more likely to score highly on conscientiousness, and lower on agreeableness than other specialty groups, and psychiatrists being more open to new experiences than the other specialty groupings.  Psychiatrists were also more likely to have required treatment for mental illness in the previous 12 months (57%) than their colleagues in other specialties (GP 42%, Hospital Service Specialties 26% and Surgeons, and Internal Medicine Specialists 25% each)

The authors recognise that personality alone is not the sole reason for a choice of specialty, but that the differences in traits between the groups of specialists, suggests some role of personality in determining ultimate choice of career path.  The authors considered the possibility of a reverse association between personality and specialty choice in that the culture of a specialists working environment may change the Doctors’ personality – leading to the observed differences.  However, this seems less likely given the usual assumption that personality is fairly fundamental and fixed over a lifetime.

As I read the paper, I thought back to my own career choice – and why I followed the path taken.  It is perhaps a little too personal to go into all of the reasoning behind my career choices here, but my career aspirations definitely changed over time.  I left medical school with thoughts of being a Trauma and Orthopaedic Surgeon (for those who know me, this may come as a shock) and I then moved through a phase wishing to be an Emergency Physician, and ultimately chose Respiratory Medicine.  At each point, there were multiple factors at play, but I certainly remember feeling more accepted in some student attachments and working environments than others.  This feeling of being ‘adopted’ into firms whilst a student, and being allowed to ‘join’ the firm once I was a doctor, I think had more of an influence than I appreciated at the time.

I therefore wonder if choice of specialty isn’t an expression of pure agency on the part of the trainee, but in fact, the other way around.  How much are students and junior colleagues ‘chosen’ by a specialty?

Lave and Wenger’s work on legitimate peripheral participation described how junior members of a community of practice become accepted and involved in the work of that community.  My feeling is that perhaps this is at play within the hidden curriculum at medical school, and our own choices about career path may be more influenced by others choice to accept us wholeheartedly into a community, or merely tolerate our presence as a fleeting member of a workforce.

In this way, personality groupings are perpetuated within the medical profession, and our stereotypes continue to live on.  If we are to facilitate the emergence of a truly diverse workforce that is happy and productive, we should not necessarily seek to eliminate these stereotypes, or encourage trainees to follow specific career paths simply based on how we interpret their personality.  Instead we should explore with trainees what draws them to a particular field of practice, and help them to see past the ‘image’ of a specialty, and make perhaps a more informed choice, taking into account how they might fit in with a particular medical tribe.




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