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Open Access Research article

Factors associated with the subspecialty choices of internal medicine residents in Canada

Leora Horn1, Katina Tzanetos2, Kevin Thorpe3 and Sharon E Straus4*

Author Affiliations

1 Department of Medical Oncology, Vanderbilt University, 777 Preston Research Building, 2220 Pierce Avenue, Nashville, TN 37232, USA

2 Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto General Hospital, 14 EN, Room 224, Toronto, ON, M5G 2C4, Canada

3 Keenan Research Center in the Li Ka Shing Knowledge Institute, 30 Bond Street, Toronto, ON, M5B 1W8, Canada and Department of Public Health Sciences, Faculty of Medicine, University of Toronto, 155 College Street, 6 Floor, Toronto, ON, M5T 3M7, Canada

4 Department of Medicine, University of Calgary, Room 1103 South Tower, 1403 29th Street NW, Calgary, AB, T2N 2T9, Canada

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BMC Medical Education 2008, 8:37  doi:10.1186/1472-6920-8-37

Published: 26 June 2008



Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions.


In this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4) subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory.


110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate). 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations they are treating.


This study suggests that internal medicine trainees, and particularly males, are increasingly choosing procedure-based specialties while non-procedure based specialties, and in particular general internal medicine, are losing appeal. We need to implement strategies to ensure positive rotation experiences, exposure to role models, improved lifestyle and job satisfaction as well as payment schedules that are equitable between disciplines in order to attract residents to less popular career choices.