title: General vs subspecialty pediatrics: factors leading to residents' career decisions over a 12-year period.
abstract: OBJECTIVE
  To determine factors motivating residents' career choices and to examine changes in these priorities over the last 12 years. During the last decade, surveys of pediatric training programs have shown trends toward residents choosing careers in general pediatrics rather than in subspecialties. Most recently, there is evidence of a shift back toward subspecialty careers.
  
  
  METHODS
  We surveyed past and present residents at The Children's Hospital of Philadelphia, Philadelphia, Pa, (training completion dates, 1991-2002) via an anonymous written questionnaire.
  
  
  RESULTS
  The sample comprised 238 residents (mean +/- SD age, 30 +/- 3 years; 59% female, 41% male; 47% subspecialists, 53% generalists). Among the group as a whole, subject matter, role models, lifestyle issues, and teaching were the most important determinants for career choices. Less important were national trends, job openings, and research. When subspecialists and generalists were compared, both groups found subject matter to be their highest priority. Among residents interested in subspecialties, teaching, research, and technical skills were significant (P<.001), compared with generalists, who considered lifestyle and personal/financial issues more important (P<.001). Lifestyle issues were also more important to female residents, those 30 years of age or younger, and those completing training recently (P<.05).
  
  
  CONCLUSIONS
  Career decisions for pediatric residents today are motivated by complex factors. For those choosing generalist careers, lifestyle and personal/financial considerations predominate, while teaching, research, and technical skills are key factors for subspecialists. Over the last decade, lifestyle issues have become a more dominant factor, particularly for women entering the pediatric workforce.
authors.affiliation: Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. harrism@email.chop.edu <harrism@email.chop.edu>
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Harris
authors.forename: Jamie
authors.initials: J
authors.lastname: Marx
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gallagher
authors.forename: Stephen
authors.initials: S
authors.lastname: Ludwig
mesh_terms: D000328:Adult; D002321:Career Choice; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008019:Life Style; D008297:Male; D009042:Motivation; D010372:Pediatrics; D012106:Research; D012456:Salaries and Fringe Benefits; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013663:Teaching; D014481:United States