Medical Specialty Selection Influences, Satisfaction, And
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MEDICAL SPECIALTY SELECTION INFLUENCES, SATISFACTION, AND IDEALSIM WITHIN THE FRAMEWORK OF CAREER COUNSELING JUDITH DAVIDSON HENNING Bachelor of Arts in Psychology Case Western Reserve University May 1970 Master of Education John Carroll University May 1977 submitted in partial fulfillment of requirement for the degree DOCTOR OF PHILOSOPHY IN URBAN EDUCATION at the CLEVELAND STATE UNIVERSITY May, 2015 ©Copyright by Judith Davidson Henning, 2015 We hereby approve the dissertation of Judith Davidson Henning Candidate for the Doctor of Philosophy in Urban Education degree This Dissertation has been approved for the Office of Doctoral Studies, College of Education and Human Services and CLEVELAND STATE UNIVERSITY College of Graduate Studies by: ______________________________________________________ Dissertation Chairperson: Sarah Toman, Ph.D. Counseling, Administration, Supervision, and Adult Learning ________________________________________________________ Methodologist: Karla Hamlen Mansour, Ph.D. Curriculum and Foundations ________________________________________________________ Kathryn C. MacCluskie, Ed.D. Counseling, Administration, Supervision, and Adult Learning _________________________________________________________ Aaron Ellington, Ph.D. Summit County ADM Board _________________________________________________________ Constance L. Hollinger, Ph.D. Psychology March 16, 2015 Student’s Date of Defense ACKNOWLEDGEMENTS Though I entered the doctoral program in 1999 and just completed my dissertation defense this spring I always knew I would complete the process and change my status from ABD to PhD. This could not have been accomplished without the support of my family and friends especially my daughter and husband to whom I cannot offer enough gratitude. Secondly I would like to thank my chairperson, methodologist and committee members. My chairperson Dr. Sarah Toman was not only extremely supportive she was also very helpful in making edits and corrections and continued her commitment to my dissertation even after she retired from the university. My methodologist Dr. Karla Hamlen Mansour, who graciously agreed to replace my original methodologist, was instrumental in retuning and refining my statistical skills. She reminded me of the importance of projecting confidence in my ability and skills. My other three committee members Dr. Aaron Ellington, Dr. Constance Hollinger, and Dr. Kathryn MacCluskie were also very helpful and provided meaningful suggestions and direction not only for this research but continuing with both research and work in this area of study and counseling. Lastly I want to thank all those who made my quest easier including those who distributed my questionnaire and those physicians who took the time to complete the questionnaire, Wanda Pruett Butler who retyped and edited my document and was also very helpful when she was the graduate office administrative assistant, Rita Grabowski who as the current administrative assistant helped me complete required paperwork and Grant Griffin who showed me how to use the SPSS program. MEDICAL SPECIALTY SELECTION INFLUENCES, SATISFACTION, AND IDEALSIM WITHIN THE FRAMEWORK OF CAREER COUNSELING JUDITH DAVIDSON HENNING ABSTRACT Because of the amount of knowledge, cost of a medical school education, length of time specialty preparation requires, and the value of achieving career satisfaction, research into the specific area of career guidance assisting aspiring physicians choose a professionally rewarding area of medical practice is critically important. Past studies in this area of specialty choice examined specific variables such as personality or gender, or specific specialty areas such as primary care, or specific populations, most often the medical students themselves. This dissertation adds to the research by asking practicing physicians to complete a questionnaire designed specifically for this study to identify their major influences in selecting a specialty, if they were satisfied practicing their area of specialty and how their idealism was related to specialty and satisfaction. The mentor relationship emerged as a significant influence in the surgery/anesthesia physician group. Clerkship and high amount of patient contact were important for the primary care group while body system interest, high income potential, high demand for services, and interest in performing specific procedures were significant non-influences for this group. Interesting as well, was that the other influences of ability/skills and lifestyle expectations were not significantly different for any of the three groups which in addition to the two above included those in a medical specialist/subspecialty category. v Primary care tended to be chosen by those who were older at graduation, those who graduated more recently and those who made their specialty decision earlier in their medical education. Medical Specialist/Subspecialty tended to be chosen by those who made a specialty choice later. Surgery/Anesthesia tended to be chosen by males and those who had higher debt. No significant differences in satisfaction levels among the different groups of physicians were found. None of the demographic differences in gender, age at graduation, debt level, having a physician parent, time of specialty choice or being born in the U.S. predicted later satisfaction levels. Generally, most physicians were satisfied in the practice of their specialty, the amount of patient contact they had, the amount of intellectual stimulation and their collegial interaction and tended to be a little less satisfied with levels of compensation and lifestyle demands. Physicians who saw themselves at the same level of idealism prior to medical school and after becoming a physician, were generally more satisfied with all aspects of their jobs. Those in the primary care groups rated themselves as being more idealistic compared to those in both surgery/anesthesia and medical specialties/subspecialties. Those in surgery/anesthesia rated their idealism as being the same as when they first chose to become a physician, as compared to those in primary care who rated themselves as currently less idealistic than when they chose to become a physician. The study further opens the door to additional research investigation in medical specialty selection. vi TABLE OF CONTENTS ABSTRACT ....................................................................................................................v LIST OF TABLES ........................................................................................................ xi LIST OF FIGURES ..................................................................................................... xiii CHAPTER I. INTRODUCTION ............................................................................................1 Definition of Terms .....................................................................................7 Research Questions ................................................................................... 10 Clinical and General Implications .............................................................. 11 Limitations ................................................................................................ 11 Conclusion ................................................................................................ 12 II. LITERATURE REVIEW ............................................................................... 13 From Generalization to Specialization ....................................................... 13 Areas of Specialization, Skills, Training, and Responsibilities ................... 15 Available Resources .................................................................................. 16 Societal and Political Influences and Impacts ............................................ 21 Research Review of Variables in Specialty Selection................................. 23 External Influences .................................................................................... 26 Training Influences ................................................................................... 35 Individual Characteristics .......................................................................... 38 Career Satisfaction .................................................................................... 54 Career success ........................................................................................... 58 Change of focus......................................................................................... 60 Including Values as a Variable and Examining the Concept of Idealism .... 61 vii Conclusion ................................................................................................ 69 III. METHODOLOGY ......................................................................................... 71 Purpose of Study ....................................................................................... 71 Research Questions ................................................................................... 71 Hypotheses ................................................................................................ 72 Design ....................................................................................................... 72 Participants................................................................................................ 74 Instrument ................................................................................................. 74 Data