Medical doctors’ specialty choice : in relation to personality, cultural capital and social background

Abstract: Globally and in Sweden, there is a lack of doctors in some medical specialities. With a growing population and increasing demand for a functional healthcare sector, there is a need to understand more about medical doctors’ specialty choices. The aim of this thesis is to obtain a deeper understanding of the processes that precede medical doctors’ specialty choice and to investigate how factors such as personality, cultural capital and social background have bearing on that choice. The four studies included in the thesis achieved this purpose. The studies were conducted in the same order as they are presented in the thesis, and studies I and II were completed before studies III and IV were designed. The first two studies were conducted with quantitative methods, whereas studies III and IV were conducted with qualitative methods. The results from studies I and II guided the research questions and methods for studies III and IV. An interpretative and pragmatic research tradition was adopted. In study I, the well-established research instrument Big Five Inventory was used to examine personality traits. In studies II and III, Pierre Bourdieu’s theoretical concepts of field, habitus and different forms of capital were used to interpret the findings. No particular theoretical framework was used in study IV, as the results were instead discussed in relation to previous research. The findings of this thesis suggest that many factors are at play in medical doctors’ specialty choice. Upbringing, school achievements, medical school and encounters with the healthcare system all have bearing on specialty choice. Furthermore, study I concluded that there are significant associations between specialty choice and personality. Surgeons had higher scores in conscientiousness and lower scores in agreeableness. Psychiatrists had higher scores in being open to new experiences, but this was not significant when adjusting for confounding factors. Study II established that medical doctors ranked perceived status differently for different specialities. Perceived status was also related to one’s own choice of specialty. The content analysis in study III revealed two themes: toward an understanding of the medical profession and different specialities and positions in the medical field. The first theme showed that social background plays a part in gaining access to medical education in the first place. Furthermore, parents who are medical doctors transfer knowledge about the specialties to their children - interpreted in this thesis as cultural capital. In the second theme, it became clear that the investments needed to become a specialist vary among specialities. It is difficult to gain access to education in the surgical specialities, whereas for other specialities there are more opportunities. The findings from study II about perceived status were reinforced, and surgical specialities stood out as having more prestige than any of the other specialities. Social networks, role models and being seen by superiors were also part of this theme. Three themes were established in study IV. In the first theme, to be invited or not, encounters with the healthcare system were important. Role models and a good work environment were positive aspects, whereas a poor work environment was a reason for rejecting a choice. In the second theme, to fit in or not, the importance of having a personality that was in line with one’s chosen specialty was explored. The third and last theme, to contribute or not, illuminated the desire to contribute to the medical field within a chosen specialty. Thoughts about disadvantaged patient groups and types of patient relations were at the core of this theme. This thesis concludes that medical doctors’ specialty choice is a long-term, complex and sometimes contradictory process in which many factors are considered. These dimensions include personal characteristics such as personality traits, social background and the formation of habitus as well as characteristics of patient relations and the type of medicine. In addition, positive and negative encounters with the healthcare system increase or decrease the likelihood of choosing a particular specialty. Finally, perceived status and prestige are central to understanding the attractiveness of different specialties.