Nationwide cross-sectional study of factors affecting specialty choice among medical interns in Egypt

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F Alqedra, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7402329/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Every year, medical interns face the challenge of choosing their future specialty. This not only affects future careers of our doctors, but also has a great impact on the healthcare system as a whole. Aim: To explore the factors influencing medical interns’ specialty choices in Egypt and assess their decision timing, commitment, and travel willingness to support career guidance and healthcare planning. Methods: A cross-sectional among interns of five universities, including four public universities (Cairo, Mansoura, Assiut, and Aswan) and a private university, Misr University for Science and Technology (MUST). The questionnaire assessed demographics, specialty choice, influencing factors (via Likert scale across four domains), and participants’ commitment to specialty. Results: 2,100 interns participated in the study. Three quarters of them decided their future specialty. prestige (mean = 4.14, ± 0.99 SD) and free time away from work (mean = 4.13, ± 1.01 SD) are the most chosen factors. Obstetrics and gynecology (10.8%) and pediatrics (8.0%) are the most chosen specialties. Conclusion: Parental education level, Grade Point Average (GPA), and advice received greatly influence interns' specialty choices. The study results provide valuable data to improve career strategies and improve shortages in the Egyptian healthcare system. specialty interns factors Egypt Career Healthcare Introduction The choice of a medical specialty is one of the most important career decisions for physicians because it not only determines their professional trajectory but also has a significant impact on healthcare systems . It decides the distribution of doctors among various specialties and consequently affects healthcare access, quality, and outcomes. Specialization affected by a number of determinants such as personal choice, income, social expectation, and organizational policy . Such insight is crucial to the solution of imbalances in the health care workforce and to the delivery of the health care needs of the population Research has confirmed that certain specialties such as surgery, internal medicine, and radiology, are preferred by medical students and interns due to their perceived status, compensation, and work-life balance . For example, a Turkish study highlighted that lifestyle and financial well-being were among the major factors driving the selection of specialties, with surgery and dermatology being the most popular specialties. Egypt, however, lacks some specialist physicians, e.g., family medicine, intensive care unit (ICU), emergency medicine, anesthesia, cardiothoracic surgery, neurosurgery, vascular surgery, and psychiatry . Poor government planning, emigration of highly qualified professionals, a lack of training opportunities, and inadequate medical education are some of the causes of this shortage. This results in long wait times, overcrowded healthcare systems, and suboptimal patient care. Additionally, it leads to burnout among medical personnel, which exacerbates the shortage. In Egypt, the health care environment has particular challenges that impact the choice of medical interns’ preferred specialties. The country has over 212,000 registered doctors with only 120,000 actively working inside its borders. Around 60,000 moved abroad for more career opportunities. This led to doctor-to-patient ratio to 0.5 doctors for every 1,000 population, far below the world average of 2.3 doctors for every 1,000 population. Majority of rural areas have been significantly affected by this shortage . Previous research on specialty choices by Egyptian medical interns has been limited in scale and typically focused on specific areas or facilities. Therefore, there is no adequate comprehensive information about affecting factors for these decisions at the national level. This gap in research suggests the need for a careful analysis of the motivations and limitations shaping medical interns' choices, particularly in a context shaped by certain economic and systemic considerations. Methods This cross-sectional study was conducted during the period from November 2024 to January 2025. This duration was specifically as interns were about to finish their internship rotations at the end of February. The study included five major universities in Egypt: Cairo University, Mansoura University, Misr University for Science and Technology (MUST, a private university), Assiut University, and Aswan University. These universities were chosen to represent different geographical regions of Egypt with consideration of availability of local collaboration to collect data. The participants were Egyptian interns from the previously mentioned medical faculties, while medical students and non-Egyptian interns were excluded from the study. The required sample size was calculated online using calculator.net ( https://www.calculator.net/samplsize-calculator.html ). The outcome of interest is the proportion of interns who decided their medical specialty. This proportion is definitely unknown, so we assumed it as 50% to get the maximum sample size with confidence level of 95%, precision of 0.05 and a design effect of 5. With approximately 8,140 registered interns, the distribution by faculty was as follows: Aswan University (231), Mansoura University (2,369), Cairo University (3,600), Misr University for Science and Technology (MUST) (860), and Assiut University (1,080). This calculation yielded a minimum sample size of 1,925 participants. The sample was distributed proportionally between different universities according to the number of registered interns. An English questionnaire, modified after Asiri et al. , was designed to take approximately 10 minutes to complete and was divided into four sections. The first section covered socioeconomics and demographics, while the second asked participants whether they had decided on their future medical specialty; if yes, they were then asked to select their chosen specialty. The third section utilized a Likert scale from 1 to 5 (1 being strongly disagree and 5 being strongly agree) for respondents to rate the factors influencing their career choices. The scale covers several domains, including Financial & Lifestyle Factors (3 factors), Work Environment and Patient Interaction (7 factors), Professional & Intellectual Factors (4 factors), and Social & External Influences (1 factor). Fourth section asked when participants had decided on their specialty, then explored their commitment levels and willingness to travel, assessing their dedication to their chosen specialty and travel preferences. The questionnaire validity and reliability were assessed through a pilot sampling of 100 medical interns to ensure its relevance, clarity, and suitability for the target population. The medical interns’ groups from campuses of different Universities were contacted to determine who would be appointed to the role of data collector. Then, the data collectors communicated with their colleagues by going through the leaders of the interns’ groups. To minimize the risk of data inflation, each university had its unique link. four of the authors were responsible for supervising the data collectors as well as the responses the participants provided to ensure that the study protocol was followed precisely among the responses collected. After data extraction, the data were edited, coded, and imported into Jamovi version 2.3.28 for analysis. Categorical variables were presented as number and percent. Descriptive analysis was performed on all variables, including interns’ socio-demographic data, academic data, family education and income, factors associated with specialty selection, most preferred specialties and commitment to specialty. Pearson chi-square and logistic regression analysis were applied to explore the potential relationships within the provided data. Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) and their 95% confidence intervals were calculated as risk measures. Quantitative data were presented as mean and SD. A P-value of < 0.05 considered significant. The Institutional Review Board of Faculty of Medicine, Mansoura University gave its ethical permission for the study’s topic and methodology on October 10,2024 (R.24.09.2806), after which the data were gathered. Results Table 1 shows that 73.3% of interns had decided their future specialty. This is significantly higher among males than females (COR=1.4), engaged (COR=1.8), high school father’s education (COR=1.7), above high school mother’s education (COR=0.7), interns of MUST university (COR=1.8), interns’ GPA B (COR=1.6) and C (COR=2.9) and interns who received advice about their future specialty from their family and relatives (COR=1.6) and Colleagues and friends (COR=2.3). Table 2 shows that the independent predictors of deciding specialty include being male (AOR=1.39), having a father with high school education (AOR=1.889), a mother with above high school education (AOR=0.553), interns of Mansoura university (AOR=0.780), having GPA B (AOR=1.439) and C (AOR=3.114) and interns who received advice about their future specialty from their family and relatives (AOR=1.933) and Colleagues & friends (AOR=2.484). Table 3 reveals that financial and lifestyle factors have a strong influence on specialty choice, as evidenced by the high ratings for monthly income (mean = 4.07), prestige and social level (mean = 4.14), and having enough free time for personal and social life away from the workplace (mean = 4.13). In particular, 76% of participants agreed that monthly income and prestige and social level were important factors in their specialty decision. Additionally, 73% agreed on the importance of having enough free time. Work Environment and Patient Interaction factors showed varied importance. The geographical place of residency program was highly valued (mean = 3.96), with 70% of participants agreeing on its importance. However, factors such as dealing with critical and dangerous cases (mean = 2.78) and dealing with a variety of patients (mean = 3.05) received lower ratings. Professional & Intellectual factors such as prefer manual work (mean = 3.50) were more favored than preference of intellectual work (mean = 2.99), indicating that a hands-on approach to patient care was more appealing to the interns. On the other hand, preferences for direct and long-term communication with patients (mean = 2.61) and indirect communication with the patient (mean = 2.51) received lower ratings. Social & External Influences, particularly advice from others, also played a role in specialty selection (mean = 3.17), with a notable percentage (38%) of interns rated as neutral. With 26.8% of interns choosing subspecialties like orthopedic surgery (5.8%) and plastic surgery (3.8%), Table 4 demonstrates that surgery was one of the most popular fields. 5.6% of interns selected general medicine, while 38.3% selected special medicine, with dermatology (7.2%) and gastroenterology (5.1%) being the most popular specialties. Obstetrics and gynecology (10.8%) and pediatrics (8.0%) also attracted a lot of attention. Lab medicine (0.2%) and family medicine (1.1%) were less popular fields, indicating that interns were less interested in them. Table 5 shows that a large proportion of participants (41.2%) decided on their specialty during the clinical years, followed by those who made their decision during their internship (36.7%). Fewer interns chose their specialty prior to joining the faculty (7.6%) or during the preclinical years (5.5%), while 9.1% do not remember. Most interns (72.9%) indicated they would switch to another specialty, while 27.1% expressed an intention to wait for an opportunity to join their preferred program if unable to join their preferred specialty program. 54.7% of interns preferred to continue their training in Egypt, while 45.3% expressed a preference for training abroad. Discussion The five universities included in this study were chosen to ensure broad geographic, demographic, and institutional representation of medical interns across Egypt. Cairo and Mansoura represent largest public universities in urban, densely populated governorates in northern Egypt with high intern volumes. Assiut and Aswan represent Upper Egypt and southern regions, capturing perspectives from less urbanized areas with different healthcare dynamics. MUST, as a prominent private institution, adds insight into career choices among interns trained in the private sector. This selection reflects a diverse spectrum of training environments, socioeconomic backgrounds, and regional healthcare needs, helping to generalize findings across the Egyptian medical intern population. The study shows out of the 2,100 participants, 1,540 (73.3%) had already chosen a specialty. Male interns were significantly more likely to have decided on their specialty than female interns (AOR = 1.39 [1.13–1.72]). The stronger inclination of male to decide on specialties could be due to several factors, including gender norms and expectations . Engaged interns were more likely to choose their specialty than single or married interns (AOR = 1.54, 95% CI: 0.95–2.49), though marital status alone didn’t significantly affect specialty choice. While being a parent influenced many medical graduates' specialty decisions in a study in United Status , factors such as passion for the field, specialty culture, and work-life balance were ultimately prioritized over parenting responsibilities. Interns whose parents had higher education levels were significantly more likely to make a decision. This indicates the significant role of family background in shaping an intern’s career trajectory. Parental education may provide access to resources, networking opportunities, and career advice, which are crucial for making early and informed specialty decisions . Academic performance is a significant predictor of specialty choice. Interns with higher GPAs, particularly those with an ‘B’ grade, were more likely to have decided on a specialty (AOR = 1.439, 95% CI: 1.143–1.812). This highlights the strong correlation between academic success and specialty decision-making. High academic achievers often have access to more competitive specialties, which may require high academic standards for entry . The university attended was another significant predictor of specialty decision-making. Interns from certain universities (MUST University, the private university in this study) were more likely to have decided on a specialty (AOR = 1.48, 95% CI: 0.98–2.24). This can be explained by the fact private universities offer more specialized resources, personalized guidance, and potentially greater exposure to diverse medical fields. The presence of family members in the healthcare field did not significantly predict whether an intern had decided on a specialty which aligns with a similar study in Saudi Arabia 8 . There is a strong influence of career advice on specialty decision-making. Interns who received advice from healthcare staff or family members were significantly more likely to have made a decision especially advice from family and relatives (AOR = 1.933, 95% CI: 1.487–2.513) and health care staff (AOR = 1.36, 95% CI: 1.031–1.788). That shows the importance of mentorship and advice from both personal connections and professionals currently working in the medical field. Colleagues and friends had the most observed effect, with an odds ratio of 2.48 (95% CI: 1.58–3.91), showing that advice from peers had the strongest influence on specialty decision-making. Selecting a medical specialty is a multifaceted decision influenced by various factors . The factors were subdivided into four categories. In terms of financial and lifestyle considerations, monthly income was identified as the third most significant factor for medical interns in Egypt, with a mean score of 4.08. This suggests that income plays a central role in specialty selection . Many interns have great interest in income as a critical consideration in their career choices given the current socio-economic state of Egypt. Prestige and social level also ranked highly, with a mean score of 4.14. This factor is in line with cultural values in Egypt, where social status and recognition are crucial. Specialties that are seen as prestigious, such as surgery or cardiology, hold significant appeal for interns due to the societal esteem and respect associated with these fields . Having Enough Free Time for Personal and Social Life (Mean = 4.13): With the second highest mean (4.13) among the three factors, work-life balance stands out as a top priority for medical interns highlighting the growing importance of mental well-being in the medical profession . When considering the work environment and patient interaction, several factors were moderately important to the interns. The data reveals that geographical location (mean = 3.96) and duration of residency (mean = 3.44) are important factors for medical interns, though not as highly prioritized as work-life balance. While geographical location is valued for convenience and lifestyle , the duration of residency is moderately considered , with interns seeking a balance between training length and career goals. Dealing with critical and dangerous cases had a mean score of 2.78, suggesting that this was not a key consideration in specialty selection. This could be attributed to the high level of stress and responsibility associated with critical cases, which might deter some interns from pursuing such high-pressure specialties . Rare specialty (mean = 2.39) was the least important factor under this category. This reflects a general disinterest in pursuing rare specialties, which could be attributed to the limited opportunities and highly competitive nature of these fields 1925 . Within the realm of professional and intellectual factors, the preference for manual work in treating patients (mean = 3.50) was moderately high. This indicates that many interns are drawn to specialties that involve hands-on procedures, such as surgery or interventionist fields, although it is not universally a top priority for all interns . In contrast, intellectual work in treating patients (mean = 3.00) received a more moderate score, indicating that while some interns enjoy the cognitive challenges of specialties like internal medicine, others may prefer more procedural roles . General surgery (7.7%) is a highly preferred specialty, however, the most popular choices within Special Surgery (26.8%) are particularly Orthopedic surgery (5.8%) and Plastic surgery (3.8%). General Medicine (5.6%) also attracted significant interest, with Dermatology (7.2%) and Cardiology (7.0%) being the leading subspecialties . In contrast, Cardio-thoracic surgery (17, 1.1%) and Pediatric surgery (6, 0.4%) are not attracting a large number of interns. This could be because these fields require specialized training and advanced medical centers, which may be lacking in Egypt. The low interest in Pulmonary (13, 0.8%) might reflect a similar pattern of limited advanced training or exposure, despite the growing need for pulmonary care, especially in the context of respiratory diseases . Family medicine also doesn't attract many interns compared to other areas, despite its importance for primary care in a country like Egypt. Only 1.1% of interns will choose family medicine, in spite of being a broad and vital specialty. This could be due to a combination of factors, such as lower prestige, fewer opportunities for advanced practice, or a lack of enthusiasm for primary care compared to more specialized fields. There are future needs for large number of family physicians especially with the nationwide implementation of social universal health insurance which is based on family practice model 5 . A study on house officers’ attitude towards family medicine and its choice as a career in Egypt found that the percentage of House Officers (HOs) who chose Family Medicine (FM) as a career increased significantly after exposure to FM-oriented training (from 15.8% pre-orientation to 50.4% post-orientation). This supports the idea that early and targeted exposure to specific specialties can influence career choices. Decision-making process of medical interns regarding their specialty choice, contingency plans, and preferences for future training locations were explored and show that most interns make their specialty choice during clinical years (41.2%) or internship (36.7%), highlighting the significant role of hands-on clinical experience in shaping decisions . A majority (74.4%) would switch to another specialty if needed, indicating flexibility in career choices, while 25.6% would wait for their preferred specialty, reflecting a strong commitment to their first choice. Regarding training locations, 54.8% prefer to train in Egypt, while 45.2% are interested in training abroad, showing the desire for international exposure which raises concerns about brain drain. To address these challenges, the Egyptian government has introduced several measures, including the expansion of private medical colleges and the enactment of the Hospital Management Law. This law gives the ability of private investors to manage public hospitals and hire up to 25% foreign medical staff. Although the goal of these policies is to address the medical workforce shortage, they have showed some worries about the job security and equitable access to healthcare. There is a newly proposed Medical Errors Law which aims to increase accountability, but may also affect the decisions made by medical interns in particular interventional specialties. There is a need for "career guidance" for Egyptian physicians and interns throughout their training programs. University mentors and healthcare policymakers should implement strategies and provide career advice to offer structured counseling services. The strength of our current study lies in the analysis of interns' choices regarding their future medical specialties at the national level which could help the Egyptian health authorities in providing a balance between various specialties. Recommendations This study suggests that Egyptian medical schools establish structured career guidance and mentorship programs especially among female interns and those from urban areas. Family medicine and other less well-known but crucial specialties should be promoted, especially in light of Egypt's Universal Health Insurance program. Public and regional universities should improve their resources and support systems, and it's important to keep an eye on how new healthcare regulations are influencing interns’ specialty choices. Longitudinal and qualitative studies are required for future research in order to monitor shifts in specialty preferences and identify more profound motivations. Researchers should compare results globally, investigate regional and socioeconomic differences, and evaluate how mentorship and policy changes affect the career choices of medical interns. Limitations Being a cross-sectional study means that it only records information at one particular moment, without the ability to show shifts in specialty preferences over time. Some response bias might have happened as participants self-reported private information like family income and educational background. The findings might also be less generalized to other nations due to the cultural and regional context of Egypt. The participants' chosen factors influencing specialty choice might need more than a 1–5 rating scale as it is a complex process. Finally, some data might be reported only because they are socially desirable. The use of online data collection is another limitation on the external validity of the findings. nonetheless, the study offers important perspectives on the factors that influence specialty selection among Egyptian interns. Conclusion 73.3% of the 2,100 participants had selected their specialty. Orthopedic surgery, dermatology, Pediatrics, general surgery and medicine were among the most frequently chosen specialties, reflecting a balanced preference for surgical and medical fields. Specially decision is significantly correlated with gender, academic achievement, and career counseling. Male interns and those with higher GPAs were more likely to select their specialty, and recommendations from medical professionals had a big impact on selection. Interns' preferences were found to be significantly influenced by work-life balance, social standing, and financial concerns. Specialties like surgery and procedural medicine, which were viewed as offering greater income and prestige, attracted more interest than specialties like family medicine and pulmonary medicine due to systemic gaps in training opportunities and perceived value. About half of medical interns want to train abroad, which could result in a brain drain that would worsen Egypt's shortage of qualified medical personnel and lower the quality of healthcare provided. In order to better align medical interns' career choices with the demands of the Egyptian healthcare system, these findings show the need for career counseling programs, advanced training facilities, and more exposure to less preferred specialties to reveal their great impact on healthcare system. Abbreviations GPA Grade point average MUST Misr University for Science and Technology ICU intensive care unit COR Crude Odds Rati AOR Adjusted Odds Ratio R Reference Declarations Competing interests The authors declare no competing interests. Ethics approval and consent to participate This study was conducted according to the principles of the Declaration of Helsinki. The Institutional Review Board of Faculty of Medicine, Mansoura University gave its ethical permission for the study’s topic and methodology on October 10,2024 (R.24.09.2806), after which data gathering began. Ethical guidelines for field research were taken into account. All participants provided informed consent prior to their inclusion in the study. They were fully informed about the study’s objectives and only those who provided their consent proceeded to complete the questionnaire. The survey was self-administered and participants were told that choosing not to complete the survey would not result in any negative consequences. Consent for publication Not applicable. Clinical trial number Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Funding No funding was received for conducting this study. Authors' contributions Mazen Ibrahem Gado contributed to the results, discussion, recommendations and limitations sections. Sally Muhamed Seliem played a key role in developing the methods section. Ali Mohammed Ali was responsible for the introduction. Jawad J. F. Alqedra contributed to the writing of the abstract. Dina Foaad Elbadry was responsible for drafting the conclusion and references. The study was supervised by Abdel-Hady El-Gilany who guided us through the whole research. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7402329","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":517790429,"identity":"78c8fe65-4437-46eb-8105-a6b507429f65","order_by":0,"name":"Mazen Ibrahem Gado","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYDCCAzAGMw8DA2MDAwM/iJNQQIoWyQaQFgNitDBAtRiARfBo4bt9gHXDjz82eQzsvMc+/NxhE218fnXihwcGDPL8YgewapE8l8B2s4cnrZiBmS95Zu+ZtNxtN95ulgA6zHDm7ASsWgzOMLDd4JE4nNjAzGPMwNt2GKjl7AaQlgSD27i13Pxj8B+shfFv2//czTPObv5BSMttnoQDYC3MvG0Hcjfw927Da4vkGca22zIHkhPbgH5hlm1Lzp1xg3ebRYKBBE6/8J1hPnbzzR+7xH7+s4cZ37bZ5fb3n91880eFjTy/NHYtkLgAAja4gARYpQQO5VgB/wFSVI+CUTAKRsEIAADZlWGSL9s4uwAAAABJRU5ErkJggg==","orcid":"","institution":"Mansoura University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mazen","middleName":"Ibrahem","lastName":"Gado","suffix":""},{"id":517790430,"identity":"e3df8434-5bd5-4fec-906f-89e9f65947ad","order_by":1,"name":"Sally Muhamed Seliem","email":"","orcid":"","institution":"Mansoura University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sally","middleName":"Muhamed","lastName":"Seliem","suffix":""},{"id":517790431,"identity":"4609ad02-96ac-4fa4-9492-c6ff0532bb8a","order_by":2,"name":"Ali Mohammed Ali","email":"","orcid":"","institution":"Mansoura University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Mohammed","lastName":"Ali","suffix":""},{"id":517790432,"identity":"cdddcab7-30af-455b-8315-e4cf05e73c70","order_by":3,"name":"Jawad J . F Alqedra","email":"","orcid":"","institution":"Cairo University hospitals","correspondingAuthor":false,"prefix":"","firstName":"Jawad","middleName":"J . F","lastName":"Alqedra","suffix":""},{"id":517790433,"identity":"a8673e13-ca40-4331-af0f-2a8ff592abe8","order_by":4,"name":"Dina Foaad Elbadry","email":"","orcid":"","institution":"Cairo University hospitals","correspondingAuthor":false,"prefix":"","firstName":"Dina","middleName":"Foaad","lastName":"Elbadry","suffix":""},{"id":517790434,"identity":"f2ce2986-6521-4825-aed6-193f2b9ad8e8","order_by":5,"name":"Abdel-Hady El-Gilany","email":"","orcid":"","institution":"Mansoura University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abdel-Hady","middleName":"","lastName":"El-Gilany","suffix":""}],"badges":[],"createdAt":"2025-08-18 18:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7402329/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7402329/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91864308,"identity":"fa0f7c42-6810-4038-818c-c0cbcd9f1b13","added_by":"auto","created_at":"2025-09-22 13:04:03","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":66261,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript1.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-7402329/v1/fccce405fdfb6d7ff5ace011.docx"},{"id":91864310,"identity":"b5acd7e0-3a2c-4b7a-8190-1aa31fbd2b84","added_by":"auto","created_at":"2025-09-22 13:04:03","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7766,"visible":true,"origin":"","legend":"","description":"","filename":"a9a1c8356e454ec6b2da75227638e0ee.json","url":"https://assets-eu.researchsquare.com/files/rs-7402329/v1/b398061f86a3f8b8a51ad756.json"},{"id":91865764,"identity":"22a127ef-6930-45e7-8dd7-f64ba21acd88","added_by":"auto","created_at":"2025-09-22 13:12:03","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84753,"visible":true,"origin":"","legend":"","description":"","filename":"a9a1c8356e454ec6b2da75227638e0ee1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7402329/v1/3eced7538aa241fa2b0e8f6f.xml"},{"id":91864312,"identity":"3a97f4ca-7005-4f9f-b44f-a370320d3f7f","added_by":"auto","created_at":"2025-09-22 13:04:03","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":82241,"visible":true,"origin":"","legend":"","description":"","filename":"a9a1c8356e454ec6b2da75227638e0ee1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7402329/v1/4549d3e0ffe877b2de806e72.xml"},{"id":91865763,"identity":"05c0dc1e-70af-4b79-a32a-f75d31530dc6","added_by":"auto","created_at":"2025-09-22 13:12:03","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93653,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7402329/v1/13d347b7f054b971ad022c6c.html"},{"id":91865765,"identity":"04ac10b0-41b7-4d9a-97f7-433851351099","added_by":"auto","created_at":"2025-09-22 13:12:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":459110,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7402329/v1/9f424516-2a4c-4722-a97c-6f04facc28ef.pdf"},{"id":91864309,"identity":"70f489d8-b5fe-4d90-b48e-fc12f66d2a60","added_by":"auto","created_at":"2025-09-22 13:04:03","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":39360,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7402329/v1/38df9a82216daf3f97379df7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nationwide cross-sectional study of factors affecting specialty choice among medical interns in Egypt","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe choice of a medical specialty is one of the most important career decisions for physicians because it not only determines their professional trajectory but also has a significant impact on healthcare systems\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e. It decides the distribution of doctors among various specialties and consequently affects healthcare access, quality, and outcomes. Specialization affected by a number of determinants such as personal choice, income, social expectation, and organizational policy\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e. Such insight is crucial to the solution of imbalances in the health care workforce and to the delivery of the health care needs of the population\u003c/p\u003e\u003cp\u003eResearch has confirmed that certain specialties such as surgery, internal medicine, and radiology, are preferred by medical students and interns due to their perceived status, compensation, and work-life balance\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e. For example, a Turkish study\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e highlighted that lifestyle and financial well-being were among the major factors driving the selection of specialties, with surgery and dermatology being the most popular specialties. Egypt, however, lacks some specialist physicians, e.g., family medicine, intensive care unit (ICU), emergency medicine, anesthesia, cardiothoracic surgery, neurosurgery, vascular surgery, and psychiatry\u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e. Poor government planning, emigration of highly qualified professionals, a lack of training opportunities, and inadequate medical education are some of the causes of this shortage. This results in long wait times, overcrowded healthcare systems, and suboptimal patient care. Additionally, it leads to burnout among medical personnel, which exacerbates the shortage.\u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e\u003c/p\u003e\u003cp\u003eIn Egypt, the health care environment has particular challenges that impact the choice of medical interns’ preferred specialties. The country has over 212,000 registered doctors with only 120,000 actively working inside its borders. Around 60,000 moved abroad for more career opportunities. This led to doctor-to-patient ratio to 0.5 doctors for every 1,000 population, far below the world average of 2.3 doctors for every 1,000 population. Majority of rural areas have been significantly affected by this shortage\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003ePrevious research on specialty choices by Egyptian medical interns has been limited in scale and typically focused on specific areas or facilities. Therefore, there is no adequate comprehensive information about affecting factors for these decisions at the national level.\u003c/p\u003e\u003cp\u003eThis gap in research suggests the need for a careful analysis of the motivations and limitations shaping medical interns' choices, particularly in a context shaped by certain economic and systemic considerations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional study was conducted during the period from November 2024 to January 2025. This duration was specifically as interns were about to finish their internship rotations at the end of February. The study included five major universities in Egypt: Cairo University, Mansoura University, Misr University for Science and Technology (MUST, a private university), Assiut University, and Aswan University. These universities were chosen to represent different geographical regions of Egypt with consideration of availability of local collaboration to collect data. The participants were Egyptian interns from the previously mentioned medical faculties, while medical students and non-Egyptian interns were excluded from the study.\u003c/p\u003e\u003cp\u003eThe required sample size was calculated online using calculator.net (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.calculator.net/samplsize-calculator.html\u003c/span\u003e\u003cspan address=\"https://www.calculator.net/samplsize-calculator.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e).\u003c/span\u003e The outcome of interest is the proportion of interns who decided their medical specialty. This proportion is definitely unknown, so we assumed it as 50% to get the maximum sample size with confidence level of 95%, precision of 0.05 and a design effect of 5. With approximately 8,140 registered interns, the distribution by faculty was as follows: Aswan University (231), Mansoura University (2,369), Cairo University (3,600), Misr University for Science and Technology (MUST) (860), and Assiut University (1,080). This calculation yielded a minimum sample size of 1,925 participants. The sample was distributed proportionally between different universities according to the number of registered interns.\u003c/p\u003e\u003cp\u003eAn English questionnaire, modified after Asiri et al.\u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e, was designed to take approximately 10 minutes to complete and was divided into four sections. The first section covered socioeconomics and demographics, while the second asked participants whether they had decided on their future medical specialty; if yes, they were then asked to select their chosen specialty. The third section utilized a Likert scale from 1 to 5 (1 being strongly disagree and 5 being strongly agree) for respondents to rate the factors influencing their career choices. The scale covers several domains, including Financial \u0026amp; Lifestyle Factors (3 factors), Work Environment and Patient Interaction (7 factors), Professional \u0026amp; Intellectual Factors (4 factors), and Social \u0026amp; External Influences (1 factor). Fourth section asked when participants had decided on their specialty, then explored their commitment levels and willingness to travel, assessing their dedication to their chosen specialty and travel preferences. The questionnaire validity and reliability were assessed through a pilot sampling of 100 medical interns to ensure its relevance, clarity, and suitability for the target population.\u003c/p\u003e\u003cp\u003eThe medical interns’ groups from campuses of different Universities were contacted to determine who would be appointed to the role of data collector. Then, the data collectors communicated with their colleagues by going through the leaders of the interns’ groups. To minimize the risk of data inflation, each university had its unique link. four of the authors were responsible for supervising the data collectors as well as the responses the participants provided to ensure that the study protocol was followed precisely among the responses collected.\u003c/p\u003e\u003cp\u003eAfter data extraction, the data were edited, coded, and imported into Jamovi version 2.3.28 for analysis. Categorical variables were presented as number and percent. Descriptive analysis was performed on all variables, including interns’ socio-demographic data, academic data, family education and income, factors associated with specialty selection, most preferred specialties and commitment to specialty. Pearson chi-square and logistic regression analysis were applied to explore the potential relationships within the provided data. Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) and their 95% confidence intervals were calculated as risk measures. Quantitative data were presented as mean and SD. A P-value of \u0026lt; 0.05 considered significant.\u003c/p\u003e\u003cp\u003e The Institutional Review Board of Faculty of Medicine, Mansoura University gave its ethical permission for the study’s topic and methodology on October 10,2024 (R.24.09.2806), after which the data were gathered.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1 shows that 73.3% of interns had decided their future specialty. This is significantly higher among males than females (COR=1.4), engaged (COR=1.8), high school father\u0026rsquo;s education (COR=1.7), above high school mother\u0026rsquo;s education (COR=0.7), interns of MUST university (COR=1.8), interns\u0026rsquo; GPA B (COR=1.6) and C (COR=2.9) and interns who received advice about their future specialty from their family and relatives (COR=1.6) and Colleagues and friends (COR=2.3).\u003c/p\u003e\n\u003cp\u003eTable 2 shows that the independent predictors of deciding specialty include being male (AOR=1.39), having a father with high school education (AOR=1.889), a mother with above high school education (AOR=0.553), interns of Mansoura university (AOR=0.780), having GPA B (AOR=1.439) and C (AOR=3.114) and interns who received advice about their future specialty from their family and relatives (AOR=1.933) and Colleagues \u0026amp; friends (AOR=2.484).\u003c/p\u003e\n\u003cp\u003eTable 3 reveals that financial and lifestyle factors have a strong influence on specialty choice, as evidenced by the high ratings for monthly income (mean = 4.07), prestige and social level (mean = 4.14), and having enough free time for personal and social life away from the workplace (mean = 4.13). In particular, 76% of participants agreed that monthly income and prestige and social level were important factors in their specialty decision. Additionally, 73% agreed on the importance of having enough free time. Work Environment and Patient Interaction factors showed varied importance. The geographical place of residency program was highly valued (mean = 3.96), with 70% of participants agreeing on its importance. However, factors such as dealing with critical and dangerous cases (mean = 2.78) and dealing with a variety of patients (mean = 3.05) received lower ratings. Professional \u0026amp; Intellectual factors such as prefer manual work (mean = 3.50) were more favored than preference of intellectual work (mean = 2.99), indicating that a hands-on approach to patient care was more appealing to the interns. On the other hand, preferences for direct and long-term communication with patients (mean = 2.61) and indirect communication with the patient (mean = 2.51) received lower ratings. Social \u0026amp; External Influences, particularly advice from others, also played a role in specialty selection (mean = 3.17), with a notable percentage (38%) of interns rated as neutral.\u003c/p\u003e\n\u003cp\u003eWith 26.8% of interns choosing subspecialties like orthopedic surgery (5.8%) and plastic surgery (3.8%), Table 4 demonstrates that surgery was one of the most popular fields. 5.6% of interns selected general medicine, while 38.3% selected special medicine, with dermatology (7.2%) and gastroenterology (5.1%) being the most popular specialties. Obstetrics and gynecology (10.8%) and pediatrics (8.0%) also attracted a lot of attention. Lab medicine (0.2%) and family medicine (1.1%) were less popular fields, indicating that interns were less interested in them.\u003c/p\u003e\n\u003cp\u003eTable 5 shows that a large proportion of participants (41.2%) decided on their specialty during the clinical years, followed by those who made their decision during their internship (36.7%). Fewer interns chose their specialty prior to joining the faculty (7.6%) or during the preclinical years (5.5%), while 9.1% do not remember. Most interns (72.9%) indicated they would switch to another specialty, while 27.1% expressed an intention to wait for an opportunity to join their preferred program if unable to join their preferred specialty program. 54.7% of interns preferred to continue their training in Egypt, while 45.3% expressed a preference for training abroad.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe five universities included in this study were chosen to ensure broad geographic, demographic, and institutional representation of medical interns across Egypt. Cairo and Mansoura represent largest public universities in urban, densely populated governorates in northern Egypt with high intern volumes. Assiut and Aswan represent Upper Egypt and southern regions, capturing perspectives from less urbanized areas with different healthcare dynamics. MUST, as a prominent private institution, adds insight into career choices among interns trained in the private sector. This selection reflects a diverse spectrum of training environments, socioeconomic backgrounds, and regional healthcare needs, helping to generalize findings across the Egyptian medical intern population.\u003c/p\u003e\u003cp\u003eThe study shows out of the 2,100 participants, 1,540 (73.3%) had already chosen a specialty. Male interns were significantly more likely to have decided on their specialty than female interns (AOR\u0026thinsp;=\u0026thinsp;1.39 [1.13\u0026ndash;1.72]). The stronger inclination of male to decide on specialties could be due to several factors, including gender norms and expectations\u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eEngaged interns were more likely to choose their specialty than single or married interns (AOR\u0026thinsp;=\u0026thinsp;1.54, 95% CI: 0.95\u0026ndash;2.49), though marital status alone didn\u0026rsquo;t significantly affect specialty choice. While being a parent influenced many medical graduates' specialty decisions in a study in United Status\u003ca class=\"FNLink\" href=\"#Fn10\" id=\"#FNLinkFn10\"\u003e\u003c/a\u003e, factors such as passion for the field, specialty culture, and work-life balance were ultimately prioritized over parenting responsibilities.\u003c/p\u003e\u003cp\u003eInterns whose parents had higher education levels were significantly more likely to make a decision. This indicates the significant role of family background in shaping an intern\u0026rsquo;s career trajectory. Parental education may provide access to resources, networking opportunities, and career advice, which are crucial for making early and informed specialty decisions\u003ca class=\"FNLink\" href=\"#Fn11\" id=\"#FNLinkFn11\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eAcademic performance is a significant predictor of specialty choice. Interns with higher GPAs, particularly those with an \u0026lsquo;B\u0026rsquo; grade, were more likely to have decided on a specialty (AOR\u0026thinsp;=\u0026thinsp;1.439, 95% CI: 1.143\u0026ndash;1.812). This highlights the strong correlation between academic success and specialty decision-making. High academic achievers often have access to more competitive specialties, which may require high academic standards for entry\u003ca class=\"FNLink\" href=\"#Fn12\" id=\"#FNLinkFn12\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eThe university attended was another significant predictor of specialty decision-making. Interns from certain universities (MUST University, the private university in this study) were more likely to have decided on a specialty (AOR\u0026thinsp;=\u0026thinsp;1.48, 95% CI: 0.98\u0026ndash;2.24). This can be explained by the fact private universities offer more specialized resources, personalized guidance, and potentially greater exposure to diverse medical fields.\u003c/p\u003e\u003cp\u003eThe presence of family members in the healthcare field did not significantly predict whether an intern had decided on a specialty which aligns with a similar study in Saudi Arabia\u003csup\u003e8\u003c/sup\u003e. There is a strong influence of career advice on specialty decision-making. Interns who received advice from healthcare staff or family members were significantly more likely to have made a decision especially advice from family and relatives (AOR\u0026thinsp;=\u0026thinsp;1.933, 95% CI: 1.487\u0026ndash;2.513) and health care staff (AOR\u0026thinsp;=\u0026thinsp;1.36, 95% CI: 1.031\u0026ndash;1.788). That shows the importance of mentorship and advice from both personal connections and professionals currently working in the medical field. Colleagues and friends had the most observed effect, with an odds ratio of 2.48 (95% CI: 1.58\u0026ndash;3.91), showing that advice from peers had the strongest influence on specialty decision-making.\u003c/p\u003e\u003cp\u003eSelecting a medical specialty is a multifaceted decision influenced by various factors\u003ca class=\"FNLink\" href=\"#Fn13\" id=\"#FNLinkFn13\"\u003e\u003c/a\u003e. The factors were subdivided into four categories. In terms of financial and lifestyle considerations, monthly income was identified as the third most significant factor for medical interns in Egypt, with a mean score of 4.08. This suggests that income plays a central role in specialty selection\u003ca class=\"FNLink\" href=\"#Fn14\" id=\"#FNLinkFn14\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn15\" id=\"#FNLinkFn15\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn16\" id=\"#FNLinkFn16\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn17\" id=\"#FNLinkFn17\"\u003e\u003c/a\u003e. Many interns have great interest in income as a critical consideration in their career choices given the current socio-economic state of Egypt.\u003c/p\u003e\u003cp\u003ePrestige and social level also ranked highly, with a mean score of 4.14. This factor is in line with cultural values in Egypt, where social status and recognition are crucial. Specialties that are seen as prestigious, such as surgery or cardiology, hold significant appeal for interns due to the societal esteem and respect associated with these fields\u003ca class=\"FNLink\" href=\"#Fn18\" id=\"#FNLinkFn18\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn19\" id=\"#FNLinkFn19\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eHaving Enough Free Time for Personal and Social Life (Mean\u0026thinsp;=\u0026thinsp;4.13): With the second highest mean (4.13) among the three factors, work-life balance stands out as a top priority for medical interns highlighting the growing importance of mental well-being in the medical profession\u003ca class=\"FNLink\" href=\"#Fn20\" id=\"#FNLinkFn20\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn21\" id=\"#FNLinkFn21\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn22\" id=\"#FNLinkFn22\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eWhen considering the work environment and patient interaction, several factors were moderately important to the interns. The data reveals that geographical location (mean\u0026thinsp;=\u0026thinsp;3.96) and duration of residency (mean\u0026thinsp;=\u0026thinsp;3.44) are important factors for medical interns, though not as highly prioritized as work-life balance.\u003c/p\u003e\u003cp\u003eWhile geographical location is valued for convenience and lifestyle\u003ca class=\"FNLink\" href=\"#Fn23\" id=\"#FNLinkFn23\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn24\" id=\"#FNLinkFn24\"\u003e\u003c/a\u003e, the duration of residency is moderately considered\u003ca class=\"FNLink\" href=\"#Fn25\" id=\"#FNLinkFn25\"\u003e\u003c/a\u003e, with interns seeking a balance between training length and career goals. Dealing with critical and dangerous cases had a mean score of 2.78, suggesting that this was not a key consideration in specialty selection. This could be attributed to the high level of stress and responsibility associated with critical cases, which might deter some interns from pursuing such high-pressure specialties\u003ca class=\"FNLink\" href=\"#Fn26\" id=\"#FNLinkFn26\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn27\" id=\"#FNLinkFn27\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eRare specialty (mean\u0026thinsp;=\u0026thinsp;2.39) was the least important factor under this category. This reflects a general disinterest in pursuing rare specialties, which could be attributed to the limited opportunities and highly competitive nature of these fields\u003csup\u003e1925\u003c/sup\u003e. Within the realm of professional and intellectual factors, the preference for manual work in treating patients (mean\u0026thinsp;=\u0026thinsp;3.50) was moderately high. This indicates that many interns are drawn to specialties that involve hands-on procedures, such as surgery or interventionist fields, although it is not universally a top priority for all interns\u003ca class=\"FNLink\" href=\"#Fn28\" id=\"#FNLinkFn28\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eIn contrast, intellectual work in treating patients (mean\u0026thinsp;=\u0026thinsp;3.00) received a more moderate score, indicating that while some interns enjoy the cognitive challenges of specialties like internal medicine, others may prefer more procedural roles\u003ca class=\"FNLink\" href=\"#Fn29\" id=\"#FNLinkFn29\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eGeneral surgery (7.7%) is a highly preferred specialty, however, the most popular choices within Special Surgery (26.8%) are particularly Orthopedic surgery (5.8%) and Plastic surgery (3.8%). General Medicine (5.6%) also attracted significant interest, with Dermatology (7.2%) and Cardiology (7.0%) being the leading subspecialties\u003ca class=\"FNLink\" href=\"#Fn30\" id=\"#FNLinkFn30\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn31\" id=\"#FNLinkFn31\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eIn contrast, Cardio-thoracic surgery (17, 1.1%) and Pediatric surgery (6, 0.4%) are not attracting a large number of interns. This could be because these fields require specialized training and advanced medical centers, which may be lacking in Egypt. The low interest in Pulmonary (13, 0.8%) might reflect a similar pattern of limited advanced training or exposure, despite the growing need for pulmonary care, especially in the context of respiratory diseases\u003ca class=\"FNLink\" href=\"#Fn32\" id=\"#FNLinkFn32\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eFamily medicine also doesn't attract many interns compared to other areas, despite its importance for primary care in a country like Egypt. Only 1.1% of interns will choose family medicine, in spite of being a broad and vital specialty. This could be due to a combination of factors, such as lower prestige, fewer opportunities for advanced practice, or a lack of enthusiasm for primary care compared to more specialized fields.\u003c/p\u003e\u003cp\u003eThere are future needs for large number of family physicians especially with the nationwide implementation of social universal health insurance which is based on family practice model\u003csup\u003e5\u003c/sup\u003e. A study on house officers\u0026rsquo; attitude towards family medicine and its choice as a career in Egypt\u003ca class=\"FNLink\" href=\"#Fn33\" id=\"#FNLinkFn33\"\u003e\u003c/a\u003e found that the percentage of House Officers (HOs) who chose Family Medicine (FM) as a career increased significantly after exposure to FM-oriented training (from 15.8% pre-orientation to 50.4% post-orientation). This supports the idea that early and targeted exposure to specific specialties can influence career choices.\u003c/p\u003e\u003cp\u003eDecision-making process of medical interns regarding their specialty choice, contingency plans, and preferences for future training locations were explored and show that most interns make their specialty choice during clinical years (41.2%) or internship (36.7%), highlighting the significant role of hands-on clinical experience in shaping decisions\u003ca class=\"FNLink\" href=\"#Fn34\" id=\"#FNLinkFn34\"\u003e\u003c/a\u003e. A majority (74.4%) would switch to another specialty if needed, indicating flexibility in career choices, while 25.6% would wait for their preferred specialty, reflecting a strong commitment to their first choice. Regarding training locations, 54.8% prefer to train in Egypt, while 45.2% are interested in training abroad, showing the desire for international exposure\u003ca class=\"FNLink\" href=\"#Fn35\" id=\"#FNLinkFn35\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn36\" id=\"#FNLinkFn36\"\u003e\u003c/a\u003e which raises concerns about brain drain.\u003c/p\u003e\u003cp\u003eTo address these challenges, the Egyptian government has introduced several measures, including the expansion of private medical colleges and the enactment of the Hospital Management Law. This law gives the ability of private investors to manage public hospitals and hire up to 25% foreign medical staff. Although the goal of these policies is to address the medical workforce shortage, they have showed some worries about the job security and equitable access to healthcare. There is a newly proposed Medical Errors Law which aims to increase accountability, but may also affect the decisions made by medical interns in particular interventional specialties.\u003c/p\u003e\u003cp\u003eThere is a need for \"career guidance\" for Egyptian physicians and interns throughout their training programs. University mentors and healthcare policymakers should implement strategies and provide career advice to offer structured counseling services. The strength of our current study lies in the analysis of interns' choices regarding their future medical specialties at the national level which could help the Egyptian health authorities in providing a balance between various specialties.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRecommendations\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study suggests that Egyptian medical schools establish structured career guidance and mentorship programs especially among female interns and those from urban areas.\u003c/p\u003e\u003cp\u003eFamily medicine and other less well-known but crucial specialties should be promoted, especially in light of Egypt's Universal Health Insurance program. Public and regional universities should improve their resources and support systems, and it's important to keep an eye on how new healthcare regulations are influencing interns\u0026rsquo; specialty choices.\u003c/p\u003e\u003cp\u003eLongitudinal and qualitative studies are required for future research in order to monitor shifts in specialty preferences and identify more profound motivations. Researchers should compare results globally, investigate regional and socioeconomic differences, and evaluate how mentorship and policy changes affect the career choices of medical interns.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLimitations\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eBeing a cross-sectional study means that it only records information at one particular moment, without the ability to show shifts in specialty preferences over time. Some response bias might have happened as participants self-reported private information like family income and educational background.\u003c/p\u003e\u003cp\u003eThe findings might also be less generalized to other nations due to the cultural and regional context of Egypt. The participants' chosen factors influencing specialty choice might need more than a 1\u0026ndash;5 rating scale as it is a complex process.\u003c/p\u003e\u003cp\u003eFinally, some data might be reported only because they are socially desirable. The use of online data collection is another limitation on the external validity of the findings. nonetheless, the study offers important perspectives on the factors that influence specialty selection among Egyptian interns.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e73.3% of the 2,100 participants had selected their specialty. Orthopedic surgery, dermatology, Pediatrics, general surgery and medicine were among the most frequently chosen specialties, reflecting a balanced preference for surgical and medical fields.\u003c/p\u003e\u003cp\u003eSpecially decision is significantly correlated with gender, academic achievement, and career counseling. Male interns and those with higher GPAs were more likely to select their specialty, and recommendations from medical professionals had a big impact on selection.\u003c/p\u003e\u003cp\u003eInterns' preferences were found to be significantly influenced by work-life balance, social standing, and financial concerns.\u003c/p\u003e\u003cp\u003eSpecialties like surgery and procedural medicine, which were viewed as offering greater income and prestige, attracted more interest than specialties like family medicine and pulmonary medicine due to systemic gaps in training opportunities and perceived value.\u003c/p\u003e\u003cp\u003eAbout half of medical interns want to train abroad, which could result in a brain drain that would worsen Egypt's shortage of qualified medical personnel and lower the quality of healthcare provided.\u003c/p\u003e\u003cp\u003eIn order to better align medical interns' career choices with the demands of the Egyptian healthcare system, these findings show the need for career counseling programs, advanced training facilities, and more exposure to less preferred specialties to reveal their great impact on healthcare system.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eGPA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGrade point average\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMUST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMisr University for Science and Technology\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICU\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eintensive care unit\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCrude Odds Rati\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdjusted Odds Ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted according to the principles of the Declaration of Helsinki. The Institutional Review Board of Faculty of Medicine, Mansoura University gave its ethical permission for the study\u0026rsquo;s topic and methodology on October 10,2024 (R.24.09.2806), after which data gathering began.\u003c/p\u003e\n\u003cp\u003eEthical guidelines for field research were taken into account. All participants provided informed consent prior to their inclusion in the study. They were fully informed about the study\u0026rsquo;s objectives and only those who provided their consent proceeded to complete the questionnaire. The survey was self-administered and participants were told that choosing not to complete the survey would not result in any negative consequences.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMazen Ibrahem Gado contributed to the results, discussion, recommendations and limitations sections. Sally Muhamed Seliem played a key role in developing the methods section. Ali Mohammed Ali was responsible for the introduction. Jawad J. F. Alqedra contributed to the writing of the abstract. Dina Foaad Elbadry was responsible for drafting the conclusion and references. The study was supervised by Abdel-Hady El-Gilany who guided us through the whole research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors would like to acknowledge voluntary participation of the medical graduates in the survey. We thank all members who distributed the questionnaires across different universities. Your support was crucial in collecting valuable data for this study.\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZisk-Rony RY, Weissman C, Avidan A. Does examining job market awareness among medical students provide insight into the specialty selection process?. Annals of Medicine. 2023 Dec 12;55(1):2201012.\u003c/li\u003e\n \u003cli\u003eAl-Ansari SS, Khafagy MA. Factors affecting the choice of health specialty by medical graduates. Journal of Family and Community Medicine. 2006 Sep 1;13(3):119-23.\u003c/li\u003e\n \u003cli\u003eAlmuhanna AF, Alsultan DH, Almohsen DS, AlHuraish DS, AlRatrout FN, Alzanadi RH, Sharbini NT. Factors Influencing Choosing Diagnostic Radiology As a Specialty Among Medical Students. 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Medical specialty choice and related factors of Brazilian medical students and recent doctors. PloS one. 2015 Jul 24;10(7):e0133585.\u003c/li\u003e\n \u003cli\u003eAnand R, Sankaran PS. Factors influencing the career preferences of medical students and interns: a cross-sectional, questionnaire-based survey from India. Journal of Educational Evaluation for Health Professions. 2019 May 15;16.\u003c/li\u003e\n \u003cli\u003eKhater-Menassa B, Major S. Factors influencing the choice of specialty among medical students in Lebanon. Le Journal Medical libanais. The Lebanese Medical Journal. 2005 Jan 1;53(1):16-20.\u003c/li\u003e\n \u003cli\u003eAzu OO, Naidu E, Naidu J. Choice of speciality amongst first-year medical students in the Nelson R. Mandela School of Medicine, University of KwaZulu-Natal. 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Pan African Medical Journal. 2015;20(1).\u003c/li\u003e\n \u003cli\u003eKhader Y, Al-Zoubi D, Amarin Z, Alkafagei A, Khasawneh M, Burgan S, El Salem K, Omari M. Factors affecting medical students in formulating their specialty preferences in Jordan. BMC medical Education. 2008 Dec;8:1-7.\u003c/li\u003e\n \u003cli\u003eHayes BW, Shakya R. Career choices and what influences Nepali medical students and young doctors: a cross-sectional study. Human resources for health. 2013 Dec;11:1-2.\u003c/li\u003e\n \u003cli\u003eHuda N, Yousuf S. Career preference of final year medical students of Ziauddin Medical University. Education for health. 2006 Sep 1;19(3):345-53.\u003c/li\u003e\n \u003cli\u003eAl-Mahdi Balla Al-Nour MB, Khalid AU, Badwi I, Jarallah JS. Career choices among Saudi medical students. Acad. Med. 1997;72:65-7.\u003c/li\u003e\n \u003cli\u003eMariolis A, Mihas C, Alevizos A, Gizlis V, Mariolis T, Marayiannis K, Tountas Y, Stefanadis C, Philalithis A, Creatsas G. General Practice as a career choice among undergraduate medical students in Greece. BMC medical education. 2007 Dec;7:1-8.\u003c/li\u003e\n \u003cli\u003eCompton MT, Frank E, Elon L, Carrera J. Changes in US medical students\u0026rsquo; specialty interests over the course of medical school. Journal of general internal medicine. 2008 Jul;23:1095-100.\u003c/li\u003e\n \u003cli\u003eElkhawaga G, Bernard B, El-Gilany AH. House officers\u0026rsquo; attitude towards family medicine and its choice as a career in Egypt. Family Practice. 2015 Apr 1;32(2):198-204.\u003c/li\u003e\n \u003cli\u003eSchroeder H, Shacham A, Amar S, Weissman C, Schroeder JE. Comparison of medical students\u0026apos; considerations in choosing a specialty: 2020 vs. 2009/10. Human Resources for Health. 2024 Jan 8;22(1):5.\u003c/li\u003e\n \u003cli\u003eRehman A, Rehman T, Shaikh MA, Yasmin H, Asif A, Kafil H. Pakistani medical students\u0026apos; specialty preference and the influencing factors. JPMA. The Journal of the Pakistan Medical Association. 2011 Jul 1;61(7):713-8.\u003c/li\u003e\n \u003cli\u003eFouad YA, Fahmy YM, Abdel Hady SM, Elsabagh AE. Egyptian future physicians are packing to leave but may be willing to return. International Health. 2015 May 1;7(3):190-4.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diedu","sideBox":"Learn more about [Discover Education](https://www.springer.com/journal/44217)","snPcode":"44217","submissionUrl":"https://submission.nature.com/new-submission/44217/3","title":"Discover Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"specialty, interns, factors, Egypt, Career, Healthcare","lastPublishedDoi":"10.21203/rs.3.rs-7402329/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7402329/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEvery year, medical interns face the challenge of choosing their future specialty. This not only affects future careers of our doctors, but also has a great impact on the healthcare system as a whole.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAim:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo explore the factors influencing medical interns\u0026rsquo; specialty choices in Egypt and assess their decision timing, commitment, and travel willingness to support career guidance and healthcare planning.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-sectional among interns of five universities, including four public universities (Cairo, Mansoura, Assiut, and Aswan) and a private university, Misr University for Science and Technology (MUST). The questionnaire assessed demographics, specialty choice, influencing factors (via Likert scale across four domains), and participants\u0026rsquo; commitment to specialty.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e\u003cp\u003e2,100 interns participated in the study. Three quarters of them decided their future specialty. prestige (mean\u0026thinsp;=\u0026thinsp;4.14, \u0026plusmn; 0.99 SD) and free time away from work (mean\u0026thinsp;=\u0026thinsp;4.13, \u0026plusmn; 1.01 SD) are the most chosen factors. Obstetrics and gynecology (10.8%) and pediatrics (8.0%) are the most chosen specialties.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParental education level, Grade Point Average (GPA), and advice received greatly influence interns' specialty choices. The study results provide valuable data to improve career strategies and improve shortages in the Egyptian healthcare system.\u003c/p\u003e","manuscriptTitle":"Nationwide cross-sectional study of factors affecting specialty choice among medical interns in Egypt","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 13:03:59","doi":"10.21203/rs.3.rs-7402329/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-15T10:47:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T09:03:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291746253070554952684894633199127752255","date":"2025-10-08T12:21:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-23T14:22:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82775453181645709946981495564655707007","date":"2025-09-13T08:14:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-12T19:52:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-08T15:37:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-21T07:17:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-21T07:17:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Education","date":"2025-08-18T18:40:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diedu","sideBox":"Learn more about [Discover Education](https://www.springer.com/journal/44217)","snPcode":"44217","submissionUrl":"https://submission.nature.com/new-submission/44217/3","title":"Discover Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bfea281a-d07d-420f-8a49-6ef569c5ae0e","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T06:56:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 13:03:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7402329","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7402329","identity":"rs-7402329","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}