Choosing to Become a Surgeon; the Impact of

Medical Student Ethnicity and Family Planning

Alex Meyer1, Austin Henderson2, Corry McDonald3, Jerrod Keith4

1Carver College of Medicine, University of Iowa, Iowa City, IA, USA2Rady School of Management, University of California San Diego, San Diego, CA, USA

3Lincoln Medical Center, Bronx, NY, USA4Department of Plastic and Reconstructive Surgery, University of Iowa, Iowa City, IA, USA

Disclosures

The authors have no relevant financial disclosures

Introduction

• Surgery or Medicine?

• What attracts students towards surgical specialties?

• What pushes them away?

Introduction

• Many previous studies have attempted to identify factors that led

trainees to pursue a certain specialty [1-10].

• This is the first study to follow students longitudinally through

their medical school career.

Methods

• Surveyed 3 full graduating classes from Carver College of Medicine at the

University of Iowa 5 times

• N=502

• Surveys at beginning of M1, M2,M3, M4 year and after residency match

Survey

Methods

• Surgical specialties:

• General surgery

• Neurosurgery

• Obstetrics/gynecology

• Ophthalmology

• Otolaryngology

• Orthopedics

• Plastic Surgery

• Urology

• Non-surgical specialties:

• Anesthesia

• Dermatology

• Family Medicine

• Internal Medicine

• Pediatrics

• Emergency Medicine

• Neurology

• Pathology

• Physical Medicine & Rehab

• Radiology

Methods

• Logit regression was used to calculate odds ratio of entering a surgical

specialty for all students.

• Students were then stratified into “Interested in Surgery in their first 2

Years of Medical School” or “Not Interested in Surgery in their first 2

Years of Medical School” and odds ratios were calculated.

ResultsDecision Factor OR (95% CI) p-value

Family in Medicine 1.23 (0.69-2.20) 0.48

Family in Surgery 2.94 (0.92 – 9.38) 0.07*

M1 surgical mentor 4.42 (1.21-16.19) 0.02**

M1 surgical research 6.77 (1.99-22.98) <0.01***

M2 surgical mentor 7.21 (3.30-15.78) <0.01***

M2 surgical research 4.50 (2.25-9.04) <0.01***

M3 surgical mentor 6.29 (2.82-13.97) <0.01***

M3 surgical research 3.77 (1.81-7.87) <0.01***

M4 surgical mentor 31.84 (5.24-193.53) <0.01***

M4 surgical research 2.67 (0.36 - 19.71) 0.337

Match surgical mentor 36.10 (12.20-106.79) <0.01***

Match surgical research 4.52 (2.32-8.81) <0.01***

* indicates p<0.10, ** p<0.05, *** p<0.01 for odds-ratio different from 1.

Results-Lifestyle/Personality Factors M1

Lifestyle/personality factors OR (95% CI) p-value

Academic vs private practice opportunities 0.96 (0.78-1.18) 0.69

Amount of time in patient contact 0.99 (0.83-1.17) 0.89

Intellectual stimulation 1.00 (0.83-1.17) 0.99

Potential Salary 1.03 (0.82-1.29) 0.83

Quality of Life 1.09 (0.91-1.31) 0.35

Responsibilities at home 1.09 (0.90-1.32) 0.38

Specialty status/reputation 0.95 (0.78-1.17) 0.65

Spouse/partner’s career 1.14 (0.91-1.42) 0.26

Technical skills necessary 0.85 (0.68-1.05) 0.13* indicates p<0.10, ** p<0.05, *** p<0.01 for odds-ratio different from 1.

Results-Lifestyle/Personality Factors-Match

Lifestyle/personality factors OR (95% CI) p-value

Academic vs private practice opportunities 1.04 (0.85-1.26) 0.70

Amount of time in patient contact 1.04 (0.86-1.25) 0.69

Intellectual stimulation 1.00 (0.84-1.20) 1.00

Potential Salary 1.00 (0.81-1.23) 1.00

Quality of Life 1.12 (0.95-1.33) 0.18

Responsibilities at home 0.92 (0.75-1.14) 0.46

Specialty status/reputation 1.38 (1.09-1.74) 0.01**

Spouse/partner’s career 0.90 (0.73-1.11) 0.31

Technical skills necessary 1.26 (1.02-1.54) 0.03**

* indicates p<0.10, ** p<0.05, *** p<0.01 for odds-ratio different from 1.

All ResultsAll Students Interested in Surgery

in their first 2 yearsNot Interested in Surgery

in their first 2 years

Female 1.115 1.6171.813

Ethnicity is White 1.177 6.472**0.590

Ethnicity is Non-White 0.849 0.155**1.694

Age at Matriculation 0.910 0.9200.840

Family Member Practices Surgery 3.209** 1.6372.928

Married in 1st 2 Years 0.246** 0.5640.103*

Has children in 1st 2 Years 2.280 5.7392.186

Mentor in Surgery in 1st 2 Years 2.783** 2.1951.647

Research in Surgery in 1st 2 years 2.960*** 4.707*1.540

Debt from Medical Education 1.553 1.3712.221

Debt Influences Specialty Preference 0.718 0.3891.090

* indicates p<0.10, ** p<0.05, *** p<0.01 for odds-ratio different from 1.

Significant Results

Odds RatiosAll Students Interested in Surgery

in their first 2 yearsNot Interested in Surgery in

their first 2 years

Mentor in Surgery in 1st 2 Years 2.783** 2.195 1.647

Research in Surgery in 1st 2 years 2.960*** 4.707* 1.540

Ethnicity is White 1.177 6.472** 0.590

Ethnicity is Non-White 0.849 0.155** 1.694

Family Member Practices Surgery 3.209** 1.637 2.928

Married without children in 1st 2 Years 0.246** 0.564 0.103*

Has children in first 2 years 2.280 5.739 2.186

* indicates p<0.10, ** p<0.05, *** p<0.01 for odds-ratio different from 1.

Conclusions

• Mentorship and research are strong predictors for pursuing a

surgical career.

• Barriers to pursuing surgical specialties are ethnicity, and familial

status.

• In order to attract the best future surgeons, we can increase the

opportunities for mentorship and research, especially for those

from diverse ethnic backgrounds.

• We need to explore ways to make surgical training more

conducive to family planning.

Acknowledgments

• Carver College of Medicine Medical Students that participated in this study

• Carver College of Medicine Administration for supporting the study

• The coauthors for their help in implementing this study

Future Work

• This study is on going

• Seven consecutive classes have now

been surveyed including current

Carver College of Medicine Students

• We hope to be able to have the power

to make conclusions on factors

influencing students to choose a

particular specialty.

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