Surgery Or General Medicine - A Study Of The Reasons Underlying The Choice Of Medical Specialty

ABSTRACT

CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty.

OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery.

TYPE OF STUDY: Stratified survey.

SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP).

METHODS: A randomized sample of resident doctors in general medicine (30) and surgery (30) was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained.

RESULTS: The moment of choice between the two specialties differed. Surgeons (30%) choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%). Most residents in both fields (73% general medicine, 70% surgery) said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%), intellectual activities (30%) and knowledge of the field (27%). For surgeons the main reasons were practical intervention (43%), manual activities (43%) and the results obtained (40%). Personality was important in the choice for 20% of general doctors and for 27% of surgeons.

RESULTS

The moment of choice

There was a significant difference between the two specialties with regard to the moment of choice for the future field of work within medicine (Figure 1). It was observed that there is less movement among those that choose surgery: 30% of the surgery residents declared that they had chosen the specialty even before starting university, in comparison with only 7% of the general medicine residents. For those that choose general medicine the decision tends to consolidate as the course progresses: 43% of the general medicine residents, in comparison with only 20% of the surgeons, made the choice of specialty during the time of internship (p = 0.055).



Stability of the choice

Although there was a difference in the moment of choice between the two specialties, most of the residents in both fields (73% in general medicine and 70% in surgery) declared that they had considered another specialty before the current choice (Table 1).



Table 2. The reasons indicated by general medicine residents were mainly the contact with patients (50%), intellectual activities (30%) and knowledge of the field (27%). When their reasons were compared with those presented by the surgery residents, statistically significant differences were found in the following categories (illustrated with some examples):








• Because of the contact with patients (p = 0.000)
"I am fascinated by the doctor-patient relationship; the choice could not be a specialty without a patient..." (Gen Med male)

· Because of the overall view of the patient (p = 0.005)
"In order to have the possibility of seeing the patient in an integrated manner..." (Gen Med male)

• Because of preference for intellectual activities (p = 0.001)
"Because I like general medicine. I really enjoy clinical reasoning; it gives me pleasure..." (Gen Med male).

• Because of the type of intervention (continuous preventive) (p = 0.040)
"The general doctor follows the patient up continuously. Chronic disease creates a tie..." (Gen Med female).

• By elimination, because of a lack of choice (p = 0.040)
"I knew what I didn't want. I never liked surgery; I don't like procedures..." (Gen Med female).

• Because the general doctor is the "true doctor"; general medicine is "what medicine is about" (p = 0.040)
"I thought being a doctor would be like this: working with reasoning and hypotheses..." (Gen Med male).

For surgery residents, the most important reasons related to the practical and objective aspects of surgical intervention (43%), the manual activities (43%) and the results obtained (40%).

The following aspects were significant for residents of the surgery area (followed by examples):

• Because of preference for manual activities (p = 0.000)
"I like to manipulate. The general doctor thinks he cures, but he doesn't put his hands on the patient to help..." (Surg male).

• Because of the type of surgical intervention (practical/objective) (p = 0.000)
"The possibility of being practical, objective. If you can't operate, then acquire patience..." (Surg male).

• Because of the results obtained (fast, visible and effective) (p = 0.000)
"Because you can see things happening through what you are doing. You can see that a tumor is being removed..." (Surg male).

• Because the surgeon is the complete doctor; surgery goes beyond general medicine (p = 0.021)
"He would be, modesty aside... a more complete doctor: he is a general doctor and also a surgeon"(Surg male).

• Because of the type of patient (acute problems) (p = 0.040)
"I don't like chronic patients. [On the other hand, through surgery] a young patient goes into the hospital and leaves well, even if the problem was acute..." (Surg male).

It is important to highlight that there were no statistically significant differences between men and women within each specialty, in relation to the reasons for the choice that were presented.

DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant.

CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries with different social and educational characteristics. This congruence indicates that the choice involves very similar desires and needs in different settings and has little dependence on the students' educational context.

Source