Data from: Specialty choice in times of economic crisis: a cross-sectional survey of Spanish medical students

Objective: To investigate the determinants of specialty choice among graduating medical students in Spain, a country that entered into a severe, ongoing economic crisis in 2008. Setting: Since 2008, the percentage of Spanish medical school graduates electing Family and Community Medicine (FCM) has experienced a reversal after more than a decade of decline. Design: A nationwide cross-sectional survey conducted online in April 2011. Participants: We invited all students in their final year before graduation from each of Spain's 27 public and private medical schools to participate. Main outcome measures: Respondents’ preferred specialty in relation to their perceptions of: (1) the probability of obtaining employment; (2) lifestyle and work hours; (3) recognition by patients; (4) prestige among colleagues; (5) opportunity for professional development; (6) annual remuneration and (7) the proportion of the physician's compensation from private practice. Results: 978 medical students (25% of the nationwide population of students in their final year) participated. Perceived job availability had the largest impact on specialty preference. Each 10% increment in the probability of obtaining employment increased the odds of preferring a specialty by 33.7% (95% CI 27.2% to 40.5%). Job availability was four times as important as compensation from private practice in determining specialty choice (95% CI 1.7 to 6.8). We observed considerable heterogeneity in the influence of lifestyle and work hours, with students who preferred such specialties as Cardiovascular Surgery and Obstetrics and Gynaecology valuing longer rather than shorter workdays. Conclusions: In the midst of an ongoing economic crisis, job availability has assumed critical importance as a determinant of specialty preference among Spanish medical students. In view of the shortage of practitioners of FCM, public policies that take advantage of the enhanced perceived job availability of FCM may help steer medical school graduates into this specialty.

研究目标：为探究2008年陷入严重且持续经济危机的西班牙，其毕业医学生专科选择的影响因素。
研究背景：2008年以来，在经历十余年下滑后，西班牙医学院毕业生选择家庭与社区医学（Family and Community Medicine, FCM）的比例出现逆转。
研究设计：2011年4月开展的全国性线上横断面调查。
研究对象：邀请西班牙27所公立与私立医学院的所有毕业前最后一年医学生参与本次调查。
主要结局指标：受访者的首选专科，与其对以下维度的认知相关：(1) 就业获得概率；(2) 生活方式与工作时长；(3) 患者认可度；(4) 同行认可度；(5) 职业发展机会；(6) 年度薪酬；(7) 医师薪酬中私人执业所占比例。
研究结果：共计978名医学生参与研究，占全国毕业前最后一年医学生总人数的25%。感知到的就业可得性对专科偏好的影响最大。就业获得概率每提升10%，选择某一专科的优势比增加33.7%（95%置信区间：27.2%~40.5%）。就业可得性对专科选择的重要程度是私人执业薪酬的4倍（95%置信区间：1.7~6.8）。研究还观察到生活方式与工作时长的影响存在显著异质性：偏好心血管外科、妇产科等专科的学生更倾向于更长而非更短的工作时长。
研究结论：在持续经济危机背景下，就业可得性已成为西班牙医学生专科选择的关键影响因素。鉴于家庭与社区医学从业者存在短缺，可借助该专科感知就业可得性提升的公共政策，助力引导医学院毕业生投身该领域。