House officers’ specialist career choices and motivators for their choice– a sequential mixed-methods study from Malaysia

Abstract Background Shortage and maldistribution of medical specialists hamper healthcare quality. The specialist career choices of house officers determine the composition healthcare system. We studied house officers’’ specialist career choices and motivators for their choice. Methods An exploratory sequential mixed-methods study was done. We conducted online in-depth interviews among seven house officers using an interview guide developed based on a literature review. The transcripts were analyzed thematically. A 33-item questionnaire was developed, and the main and sub-themes were identified as motivators for specialist career choice. An online survey was done among a random sample of 185 house officers. Content validation of motivators for specialist choice was done using exploratory factor analysis. First, the second and third choices for a specialist career were identified. Multinomial logistic regression analyses were done to determine the socio-demographic factors and motivators associated with the first choice. Results Two major themes were identified from the in-depth interviews with house officers. Perceptions about specialist training opportunities were positive as they gain a wide range of clinical competencies through well-structured, comprehensive training programs under existing specialist training pathways. However, the limited availability of Malaysian local university training opportunities and challenges of ‘on-contract’ to pursue specialist training were the main challenges. The motivational factors for first-choice specialty were related to ‘work schedule’, ‘patient care characteristics’, ‘specialty characteristics’, ‘personal factors’, ‘past work experience’, ‘training factors’, and ‘career prospects.’ Overall Cronbach’s alpha for the questionnaire on motivators was 0.85. Exploratory factor analyses retained 26 out of 33 items in seven constructs with a 64.9% variance. House officers’ first choices were specialties related to medicine (40.5%), surgery (31.5%), primary care (14.6%), and acute care (13.5%). On multivariate analysis, “younger age”, “health professional in the family”, “work schedule and personal factors”, “career prospects” and “specialty characteristics” were associated with the first choice. Conclusions Specialties related to medical and surgical disciplines were the most preferred disciplines. Motivators for the first choice varied by discipline. The information motivational factors are helpful to develop policies to encourage more doctors to choose specialties with a shortage of doctors and to provide career specialty guidance.