Study design
The study is a cross-sectional survey. All physicians in the target population were invited to participate by a postal invitation letter containing a paper version of the questionnaire in either French or German language. Additionally, a link was provided leading to an identical online questionnaire. An identification code assured that only a single entry per participant was considered in the analysis. Five weeks after the first postal letter, a second postal letter was sent to non-respondents only. Both preliminary versions of the French as well as the German questionnaire were pre-tested with 15 physicians from the study population.
Questionnaire
To gain insights on factors potentially influencing the career choice of medical students and residents, we conducted a literature search with the scope of general medicine, career planning and specialty choice to compose the questionnaire.
Inclusion criteria were verified with questions about years and types of board certifications.
Baseline characteristics: To characterize the study population, we included questions about demographic characteristics (sex, current age) education (age at end of medical school, place of graduation) and residency (PCP vocational training, residency at academic hospital, months of outpatient work) and current work situation (part-time, leading position, employed vs self-employed, setting, working half-days a week).
Primary outcome: The primary outcome final career choice was defined as the participants’ answer to the question “What will be your main lifetime activity”. Possible answers were: “PCP”, “hospital internist”, “subspecialists” and “other”. If the box “other” was ticked, we reclassified the participants based on their free-text answer. We reclassified them as PCP if they did not have a second board certification and currently worked in a practice. We reclassified them as “subspecialists” if they indicated a second board certification and as “hospital internist” if they were working in hospital without a second board certification. Those who were not working with patients or who did not fulfill one of the categories were classified as “others”. As our focus was PCP as a career choice, we categorized respondents as PCP versus non-PCP to compare the association of influencing factors with final career choice. Non-PCP included respondents with answers: hospital internists, subspecialists, and other career choices.
Secondary outcomes and influencing factors: To compare timing of final career choice over categories we asked “When did you decide about your main lifetime activity?” with a multiple choice answer. To investigate factors associated with the final career choice we asked about perceived influence of participants’ peers on final career choice, availability of resident positions and practice moratorium (i.e., a federal law restricting the opening of private practices in Switzerland from 2002 to 2011).
Finally we explored (non-mutually-exclusive) attractiveness of following careers: “being an internist without further subspecialty”, “being a specialist”, “working in a practice” and “working in a hospital” at different biographical time intervals: “during medical school”, “during internal medicine residency” and “final career choice”. We categorized a career in primary care to be perceived as attractive if participants rated “working in a practice” and “being an internist without further subspecialty” as attractive within the same biographical time interval.