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, USA 2Rady School of Management, University of California San Diego, San Diego, CA, USA 3Lincoln Medical Center, Bronx, NY, USA 4Department 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 • Non-surgical specialties: • Neurosurgery • Anesthesia • Obstetrics/gynecology • Dermatology • Ophthalmology • Family Medicine • Otolaryngology • Internal Medicine • Orthopedics • Pediatrics • Plastic Surgery • Emergency Medicine • Urology • 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. Results Decision 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 * indicates0.85 p<0.10, (0.68 ** p<0.05,-1.05) *** p<0.01 for odds0.13-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 Results

All Students Interested in Surgery Not Interested in Surgery in their first 2 years in their first 2 years 1.813 Female 1.115 1.617 0.590 Ethnicity is White 1.177 6.472** 1.694 Ethnicity is Non-White 0.849 0.155** 0.840 Age at Matriculation 0.910 0.920 2.928 Family Member Practices Surgery 3.209** 1.637 0.103* Married in 1st 2 Years 0.246** 0.564 2.186 Has children in 1st 2 Years 2.280 5.739 1.647 Mentor in Surgery in 1st 2 Years 2.783** 2.195 1.540 Research in Surgery in 1st 2 years 2.960*** 4.707* 2.221 Debt from Medical Education * indicates1.553 p<0.10, ** p<0.05,1.371 *** p<0.01 for odds-ratio different from 1. 1.090 Debt Influences Specialty Preference 0.718 0.389 Significant Results

All Students Interested in Surgery Not Interested in Surgery in Odds Ratios in their first 2 years 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

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