Participants, methods, and results

The survey population comprised all graduates from all medical schools in the United Kingdom in 1999 and 2000. We used graduation lists from each medical school to compile our database. The doctors were sent a questionnaire towards the end of their preregistration year; non-respondents were sent a maximum of four reminders. As in earlier surveys,1^–4 graduates were asked to state up to three choices of long term career in order of preference and to indicate whether they intended to practise medicine in the United Kingdom for the foreseeable future. We grouped career choices specified by the respondents into 14 mainstream specialties based on those defined in the Todd report.5 We used χ² statistics and adjusted residuals to compare cohorts.1

The two cohorts consisted of 8661 graduates, of whom 23 were unregistered at the time of the surveys. Of the 8638 who were registered, 20 declined to participate, two were known to be dead, and 122 were untraceable. The remaining 8494 comprised 4104 men and 4390 women, of whom 5702 (67.1%) replied. The proportion of women graduates who responded was significantly higher than that of the men (73.7% v 60.1%, χ²=175.9, df=1, P<0.001).

The table shows the junior doctors' first choices of long term mainstream specialty and compares them with the respondents of 1996 (table). We found no difference in the distribution of first choices between the graduates of 1999 and 2000 (χ²=14.1, df=13, P>0.05) and a significant difference between those of 1999 and 2000 combined and 1996 (χ²=83.5, df=13, P<0.001). Choices for general practice increased, whereas choices for hospital medical specialties, surgical specialties, paediatrics, and obstetrics and gynaecology decreased (the latter halved). Differences between men and women in choices of specialty remain substantial.

Of the graduates from 1999 and 2000, 10.3% (583) “definitely” or “probably” did not intend to practise medicine in the United Kingdom for the foreseeable future. Including those who were undecided, 25% (1418) had doubts about practising medicine in the United Kingdom. The corresponding figures were 9.0% (263) and 22.2% (648) for the 1996 cohort and 9.7% (251) and 24.3% (631) for the 1993 cohort.

Comment

The percentage of newly qualified doctors intending to enter general practice has increased from 20% in 1996, the lowest percentage recorded in our surveys, but remains much lower than the figure of 40-50% of the qualifiers of the 1970s and 1980s.1 Concerns about career prospects in obstetrics and gynaecology have reduced the numbers choosing this specialty to the lowest ever recorded in our surveys. Changes in choice for other specialties are less striking.

The government is substantially increasing the number of places at medical schools. Knowledge of young doctors' career choices will help planners to anticipate whether future service requirements in different specialties will be met from United Kingdom sources.