Factors associated with the choice of general medicine as a career among Japanese medical students

Figures & data

Table 1 Characteristics of participants by level of interest in choosing GM/FM as a career

		General physician/family physician, N (%)
	Total	Most interested	Interested	Others
Characteristics	N=368	N=69	N=156	N=143	P for trend
Gender
Women	141 (38.3)	27 (39.1)	63 (40.4)	51 (35.7)	0.695
Men	227 (61.7)	42 (60.9)	93 (59.6)	92 (64.3)
Age, years	21.4±3.6	21.3±2.3	21.7±4.0	21.2±3.6	0.538
Academic year
1st–2nd	179 (48.6)	31 (44.9)	69 (44.2)	79 (55.2)	0.129
3rd–5th	189 (51.4)	38 (55.1)	87 (55.8)	64 (44.8)
Admission from hometown
Yes	168 (45.7)	43 (62.3)**	64 (41.0)	61 (42.7)	0.008
No	200 (54.3)	26 (37.7)	92 (59.0)	82 (57.3)
Public high school graduation
Yes	195 (53.0)	46 (66.7) ***	85 (54.5)	64 (44.8)	0.010
No	173 (47.0)	23 (33.3)	71 (45.5)	79 (55.2)
Combined junior high and high school graduation
Yes	164 (44.6)	22 (31.9)**	66 (42.3)	76 (53.1)	0.011
No	204 (55.4)	47 (68.1)	90 (57.7)	67 (46.9)
Admission by a special policy
Yes	23 (6.3)	9 (13.0)*	8 (5.1)	6 (4.2)	0.033
No	345 (93.8)	60 (87.0)	148 (94.9)	137 (95.8)
Student preparing for the entrance exam next year
Yes	175 (47.6)	40 (58.0)	67 (42.9)	68 (47.6)	0.115
No	193 (52.4)	29 (42.0)	89 (57.1)	75 (52.4)
Presence of medical relatives
Yes	162 (44.0)	23 (33.3)	72 (46.2)	67 (46.9)	0.139
No	206 (56.0)	46 (66.7)	84 (53.8)	76 (53.1)
Growing up in a rural area
Yes	47 (12.8)	10 (14.5)	18 (11.5)	19 (13.3)	0.809
No	321 (87.2)	59 (85.5)	138 (88.5)	124 (86.7)
Intent for rural practice
Yes	66 (17.9)	20 (29.0)**	27 (17.3)	19 (13.3)	0.020
No	302 (82.1)	49 (71.0)	129 (82.7)	124 (86.7)

P for trend from ANOVA for continuing variables and χ²-test for categorical variables. *P<0.05, *P<0.01, and ***P<0.005 versus ‘other’ groups. Numbers in bold indicate significance (p<0.05).

Table 2 Factor analysis of specialty preferences associated with future career plans

	Factor structure (Factor loading)
Item	1	2	3	4	5	6
Factor 1: Educational experience (Cronbach's α=0.84)
15) Received excellent teachings	0.92	0.13	−0.12	−0.06	0.06	−0.06
14) Memorable experience at a class or clinical rotation	0.79	0.10	−0.08	−0.08	0.02	0.13
16) Comfortable atmosphere at the specialty department	0.77	−0.11	0.02	0.16	−0.10	−0.01
17) Encounter with role model teachers	0.56	−0.19	0.26	0.08	−0.03	−0.01
Factor 2: Job security (Cronbach's α=0.73)
19) Advice/expectation of parents	0.05	0.59	0.11	−0.19	−0.09	0.07
26) Expected income	0.01	0.58	−0.06	0.32	0.07	0.09
24) Ease of opening a practice	−0.10	0.54	−0.01	0.19	0.20	0.04
25) Expectation to inherit the practice of my parents/relatives	−0.09	0.50	−0.00	0.03	−0.13	0.11
23) Job availability	0.18	0.46	0.10	0.09	0.04	−0.06
Factor 3: Advice from others (Cronbach's α=0.81)
20) Advice from senior students/residents	−0.04	0.04	0.84	0.01	−0.12	0.04
21) Advice from teachers/consultants	0.07	−0.02	0.81	0.01	0.05	−0.05
22) Influence of friends	−0.08	0.16	0.57	0.04	−0.01	0.04
Factor 4: Work–life balance (Cronbach's α=0.78)
27) Working hours	−0.02	0.02	0.03	0.84	−0.01	−0.07
28) Attainable lifestyle	0.06	0.04	−0.02	0.67	0.11	0.01
30) Risk of any malpractice law suits	0.04	0.16	0.10	0.52	−0.06	0.02
Factor 5: Scientific orientation (Cronbach's α=0.70)
5) Interest in surgical procedures or technologies	−0.08	0.13	0.08	−0.21	0.77	−0.14
6) Mastering a specialty	0.00	−0.08	−0.00	0.04	0.62	−0.02
4) Interest in research or scientific aspects	−0.00	−0.10	−0.03	0.16	0.60	0.24
2) Interest in organ specialty	0.05	−0.07	−0.03	0.11	0.48	0.04
Factor 6: Personal reasons (Cronbach's α=0.55)
11) I suffer(ed) from an illness in that specialty	−0.11	0.02	−0.09	0.15	−0.03	0.56
12) Friend/family suffer(ed) from an illness in that specialty	−0.02	0.10	0.09	−0.09	0.01	0.56
13) Became interested in the specialty before medical school	0.12	0.12	−0.02	0.15	−0.01	0.42
3) Interest in targeted populations such as children or the elderly;	0.12	−0.13	0.07	−0.09	0.11	0.38
Factor: Inter-factor correlations	1	2	3	4	5	6
1	1.00
2	0.16	1.00
3	0.29	0.46	1.00
4	0.25	0.53	0.47	1.00
5	0.08	−0.01	0.03	0.88	1.00
6	0.22	0.18	0.20	0.09	0.12	1.00

The factor analysis was conducted with IBM SPSS using a maximum likelihood method and promax rotation. Items excluded from the factor analysis because of a ceiling effect were: 1) Interest in clinical work of the specialty and 8) I feel it rewarding to work in the specialty, low factor loading (<0.35); 7) I have an aptitude for the specialty; 9) Prospect for further development of the field; 10) Highly respected in society; and 29) Influence of future health care reform, correlation with two factors to the same extent; 18) Encounter with a role model junior doctor

Table 3 Relationship between confounding factors and level of interest in choosing GM/FM as a career

	1st choice=1 and 2nd choice+others=0 N=368		1st choice=2, 2nd choice=1 and others=0 N=368
Characteristics	r (p-value)	β (p-value)	r (p-value)	β (p-value)
Gender (Men: 1, Women: 0)	−0.008 (0.878)	–	−0.033 (0.525)	–
Age	−0.020 (0.695)	–	0.017 (0.740)	–
Academic year	0.036 (0.495)	–	0.089 (0.088)	0.120 (0.023)
Admission from hometown	0.161 (0.002)	0.189 (0.001)	0.188 (0.024)	–
Public high school graduation	0.132 (0.011)	–	0.158 (0.002)	0.157 (0.002)
Combined junior high and high school graduation	−0.123 (0.019)	–	−0.157 (0.003)	–
Admission by a special policy	0.135 (0.010)	–	0.117 (0.025)	0.105 (0.043)
Student preparing for the entrance exam	0.100 (0.055)	0.172 (0.001)	0.053 (0.306)	–
Presence of medical relatives	−0.103 (0.047)	−0.107 (0.037)	−0.045 (0.384)	–
Growing up in a rural area	0.025 (0.636)	–	−0.012 (0.814)	–
Intent for rural practice	0.138 (0.008)	0.123 (0.016)	0.138 (0.008)	0.128 (0.014)
Future career plans
Educational experience	0.054 (0.300)	–	0.050 (0.340)	–
Job security	0.037 (0.483)	–	0.041 (0.438)	–
Advice from others	0.056 (0.288)	–	0.028 (0.593)	–
Work–life balance	0.092 (0.079)	0.126 (0.013)	0.067 (0.199)	–
Scientific orientation	−0.098 (0.061)	−0.125 (0.013)	−0.136 (0.009)	−0.116 (0.024)
Personal reasons	0.025 (0.629)	–	0.034 (0.521)	–
R ^2	–	0.085 (<0.001)	–	0.082 ( p< 0.001)

r, Pearson's correlation coefficient; β, standardized coefficient; R ², coefficient of determination. ‘–’ was not retained in the final model by multiple linear regression analysis (stepwise method). Numbers in bold indicate significance (p<0.05).

 To what extent do the following reasons for choosing a specialty match your own? Please circle one response for each factor.

(4. extremely, 3. fairly well, 2. not particular, 1. not at all)
1. Interest in clinical work of the specialty:	4	3	2	1
2. Interest in an organ of the specialty	4	3	2	1
3. Interest in the targeted population (e.g., children, the elderly)	4	3	2	1
4. Interest in research or scientific aspects	4	3	2	1
5. Interested in surgical procedures or technologies	4	3	2	1
6. Mastering the specialty	4	3	2	1
7. I have an aptitude for the specialty	4	3	2	1
8. I feel it rewarding to work in the specialty	4	3	2	1
9. Prospect for further development of the field	4	3	2	1
10. Highly respected in society	4	3	2	1
11. I suffer(ed) from an illness of the specialty	4	3	2	1
12. Friend/family suffer(ed) from an illness of the specialty	4	3	2	1
13. Because I was interested in the specialty before medical school	4	3	2	1
14. Memorable experience at a class or clinical rotation	4	3	2	1
15. Received excellent teaching	4	3	2	1
16. Comfortable atmosphere at the specialty department	4	3	2	1
17. Encounter with role model teachers	4	3	2	1
18. Encounter with role model junior doctors	4	3	2	1
19. Advice/expectation of parents	4	3	2	1
20. Advice from senior students/residents	4	3	2	1
21. Advice from teachers/consultants	4	3	2	1
22. Influence of friends	4	3	2	1
23. Job availability	4	3	2	1
24. Ease of opening a practice	4	3	2	1
25. Expectation to inherit a practice of my parents/relatives	4	3	2	1
26. Expected income	4	3	2	1
27. Working hours	4	3	2	1
28. Attainable lifestyle	4	3	2	1
29. Influence of future health care reforms	4	3	2	1
30. Risk of malpractice law suits	4	3	2	1