Abstract

Background: To augment the availability of medical care for a population that is older and more ethnically diverse, the number of US medical schools is increasing and existing medical schools are enlarging their class sizes. Predictors of specialty choice, especially primary care careers, are helpful to medical school officials and faculty involved in medical school recruitment and counseling and to students planning their career paths.
Objective: The objective was to examine the association between personality characteristics and specialty choice.

Methods: The Neuroticism-Extraversion-Openness Personality Inventory Revised (NEO PI-R) was administered to 4 Tulane University School of Medicine (New Orleans, Louisiana) classes (2003-2006). The NEO PI-R is a measure of 5 personality characteristics (neuroticism, extraversion, openness, agreeableness, and conscientiousness), with each domain having 6 underlying facets. The specialty choice of graduates was obtained from the National Residency Matching Program.
Results: Starting in 1999, 595 students matriculated and by June 2006, 542 (91%) had matched to residency programs in 22 specialties. There were differences among specialties for neuroticism (P = .006), openness (P < .001), and agreeableness (P = .003), but not for extraversion (P = .173) or conscientiousness (P = .103). Various pairwise differences between specialty categories were found.
Discussion: Eleven specialty categories were compared using the NEO PI-R. Numerous specialty variations were identified for neuroticism, openness, and agreeableness. The findings may be useful to medical school officials and faculty who recruit and counsel students and to students themselves as they reflect on their personality characteristics on their path to making career choices.

Introduction

Today state governments, professional organizations, and healthcare entities are pursuing initiatives to increase the number of medical schools and medical school graduates in the United States.[1] This surge to augment the availability of medical care for a population that is older and more ethnically diverse than in prior decades inevitably raises the issue of access to primary care.[2] Between 1998 and 2006, the proportion of medical school graduates entering the primary care specialties of internal medicine, pediatrics, and family medicine decreased from 50% to 38%.[3] Further, the percentage of third-year internal medicine residents planning general internal medicine careers (other than as a hospitalist) decreased by half between 1998 and 2003 (54% to 27%), and only 19% of first-year internal medicine residents in 2003 planned a primary care career.[4]

A varied list of predictors of specialty choice have been studied, including demographic and socioeconomic factors, academic achievement, medical school curricula, and lifestyle plans.[5,6] A prominent area of investigation has been psychological or personality characteristics.[7] We examined the relationship between a 5-factor personality model and specialty choice for 4 classes of medical school graduates. An earlier investigation reported the findings for the first class (class of 2003) in our study.[8]

Materials and Methods

Four Tulane University School of Medicine classes (2003-2006) were included in the study. Starting in August 1999, 595 students matriculated as first-year medical students, and by June 2006, 542 (91%) had matched to residency programs in 22 specialties.

The Neuroticism-Extraversion-Openness Personality Inventory Revised (NEO PI-R)[9] is a 240-item self-report of descriptions of behavior. Responses are scored on a 5-point strongly agree to strongly disagree (Likert) scale. The NEO PI-R is a measure of 5 personality characteristics (neuroticism, extraversion, openness, agreeableness, and conscientiousness) with each domain having 6 underlying facets. The 5 domains of the NEO PI-R are neuroticism – tendency to experience negative emotional states (example facets: anxiety, hostility, and depression); extraversion – sociability (example facets: warmth, gregariousness, and assertiveness); openness – focus on intellectual curiosity and independent judgment (example facets: fantasy, aesthetics, and feelings); agreeableness – pleasant and accommodating in social situations (example facets: trust, altruism, and compliance); and conscientiousness – painstaking and careful behavior guided by conscience (example facets: order, dutifulness, self-discipline). The internal consistency and test-retest reliability and the convergent and discriminant validity of the NEO PI-R are satisfactory.[9]

The Tulane University Institutional Review Board approved the study. Students gave their written consent to participate in the study and completed the NEO PI-R within 2 weeks of medical school matriculation. The specialty choice of graduates was obtained from the National Residency Matching Program.

For statistical purposes, the analysis included only specialties with 10 or more graduates (n = 502 or 93% of the 542 graduates). NEO PI-R data were available for 479 of these 502 graduates (95%). Two covariates were collected: age (n = 473 of 479; 99%) and scores on the Medical College Admission Test (MCAT) (n = 450 of 479; 94%). Change in specialty choice from matriculation to residency match was also recorded (n = 461).

Differences among specialties on the covariates of age and MCAT and the dependent variables (ie, the 5 domains of the NEO PI-R) were examined with analysis of variance (ANOVA) followed by the Least Square Difference post hoc method for pairwise comparisons. The t-test was used to examine graduates who changed or did not change specialty choice on the covariates and the dependent variables. Inferences were made at the .05 level of significance for all tests except for post hoc comparisons. To avoid capitalizing on chance, a more stringent alpha of .01 was established for the post hoc tests.

Results

The 11 specialties with more than 10 graduates were internal medicine (n = 105), surgery (104), pediatrics (50), family medicine (42), radiology (35), psychiatry (32), anesthesiology (28), emergency medicine (27), obstetrics-gynecology (27), internal medicine/pediatrics (16), and dermatology (13).

The mean age at graduation for 473 subjects was 27.5 years (SD = 3.0), and the mean MCAT composite score (physical sciences, verbal reasoning, and biological sciences) for 450 subjects was 30.5 (SD = 3.4). The 11 specialty groups did not differ on either covariate: MCAT composite (P = .08); age (P = .45). Consequently, we did not adjust for MCAT composite scores or age when examining the relationship between specialty and NEO PI-R.

There were differences among specialties for neuroticism (P = .006), openness (P < .001), and agreeableness (P = .003), but not for extraversion (P = .173) or conscientiousness (P = .103) ( Table 1 ). Neuroticism scores for graduates entering internal medicine were higher than anesthesiology, and scores for graduates entering pediatrics or radiology were higher than anesthesiology and surgery. Openness scores for graduates entering psychiatry were higher than anesthesiology, dermatology, emergency medicine, family medicine, pediatrics, radiology, and surgery, and scores for graduates entering obstetrics-gynecology were higher than anesthesiology, dermatology, radiology, and surgery. Conscientiousness scores for graduates entering radiology were lower than anesthesiology, dermatology, family medicine, internal medicine, internal medicine/pediatrics, and obstetrics-gynecology, and scores for graduates entering family medicine were higher than surgery.

There were no differences between graduates who changed specialty from self-reported preference at matriculation to residency match and those who did not change on the 4 NEO PI-R scales: neuroticism (P = .52), extraversion (P = .36), agreeableness (P = .45), and conscientiousness (P = .72) ( Table 2 ). On the domain of openness, there was a marginally significant difference (P = .071) with, not surprisingly, those who changed specialty choice from matriculation to graduation being more open to change than their colleagues whose specialty choice remained stable throughout medical school.

Discussion

Medical schools, state governments, professional organizations, and the healthcare community as a whole are taking actions to improve access to medical care for US citizens. Many of these measures are designed to increase physician manpower and a better admixture of medical and surgical specialties. As the proportion of medical school graduates entering primary care specialties decreases, initiatives to ensure access to practitioners of family medicine, general internal medicine, and general pediatrics are essential. In this spirit medical education and health affairs researchers have investigated predictors of specialty choice for decades. Areas of study have included demographic characteristics, such as sex, age, socioeconomic status, and hometown size as well as academic indicators, such as MCAT scores, medical school grade point average (GPA), United States Medical Licensing Examination (USMLE) scores, and curricular innovations.[10-12] More recently, lifestyle preferences have come under scrutiny.[13] In addition, psychological instruments have been widely used to identify psychological correlates of specialty choice.[7]

We investigated 4 classes of graduates from one private medical school to examine the relationship between 5 core personality characteristics and specialty choice. Eleven medical and surgical specialty categories were compared employing the NEO PI-R.[9]

Although no specialty differences were found for the domains of extraversion and conscientiousness, numerous specialty variations were identified for neuroticism, openness, and agreeableness.

Our findings may be useful to medical school faculty and staff who recruit and counsel students. Ethical considerations likely would preclude medical schools from using personality instruments, such as the NEO PI-R, to establish prescribed criteria for selecting which applicants are admitted. However, research findings suggesting that certain personal and psychological factors are associated with a given medical or surgical specialty can be valuable background knowledge for admission officials or interviewers.

Characteristics related to practicing primary care medicine are of greater interest to those medical schools with mission statements that include producing primary care physicians to serve state or regional healthcare needs.

Medical students often find it helpful to reflect on their personality, values, and interests on their path to making career choices. Our findings add to the literature available to students seeking to identify the specialty that best matches their personal characteristics. In recent years medical students have found the Careers in Medicine Web site of the Association of American Medical Colleges (AAMC) to be especially helpful for assessing one’s personality and matching one’s profile to specialty options.

Although many other factors (eg, academic achievement, financial considerations, and lifestyle preferences) influence specialty choice, intrapersonal aspects (interests, values, and personality characteristics) also have an impact on the medical graduate’s decision. Earlier research on the association between personality/psychological features and medical/surgical specialties was extensive[7] but may not be generalizable to today’s medical graduate, members of the so-called millennials (born between 1980 and 1995). Additional research is needed to determine whether the relationships between personality features and specialty choices differ for today’s medical school graduates compared with past generations.

Reviewed by Dr. Ramaz Mitaishvili