Int J Pharm Pharm Sci, Vol 15, Issue 2, 60-63Original Article

CHOICE OF MEDICAL PROFESSION-PASSION OR PRESSURE: MEDICAL STUDENTS PERSPECTIVES

RAMANATHAN RASHMI1, SHANMUGAM JEEVITHAN2*, MAGADI GOPALKRISHNA SRIDHAR3, THANEERPANDHAL PALANISAMY KALANITHI4

1Professor in Physiology, KMCH Institute of Health Sciences and Research, Coimbatore–14, 2Professor in Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore–14, 3Professor in Biochemistry, KMCH Institute of Health Sciences and Research, Coimbatore–14, 4Professor in Internal Medicine, KMCH Institute of Health Sciences and Research, Coimbatore–14
Email: dr.jeevithan@gmail.com

Received: 02 Nov 2022, Revised and Accepted: 21 Dec 2022

ABSTRAC

Objective: Medical profession is one of the most aspired career option among school students and parents. Though the profession may look so lucrative and charming, one needs to be committed a lot to become a successful doctor. Passion and interest towards the career will be the most determining option to be a successful practitioner. But there will be many external influences in a student’s life to choose this career. This study was conducted with the objective to understand the factors that influenced MBBS students to choose this career.

Methods: An analytical cross-sectional study was conducted among 1060 MBBS students throughout India. A self-designed questionnaire which contained questions related to why they selected this career was prepared and validated among experts in the field and was converted into google forms and was circulated to all the medical colleges in India through social media platform.

Results: Though the majority (60.4%) mentioned that passion to serve as the main reason, nearly one-fourth (25.8%) have opted the career for social status, job opportunity, good remuneration and lifestyle. Nearly one-third (32%) have regretted joining the profession. Regarding the plan after MBBS, most of them (59.2%) preferred speciality practice. Clinical subjects were the most preferred Postgraduation.

Conclusion: Though passion for the medical profession was the most common reason for coming into this career, parental and few other external influences were also found as the reasons for choosing MBBS among some students.

Keywords: Medical profession, MBBS Students, Career opportunities

© 2023 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijpps.2023v15i2.46726. Journal homepage: https://innovareacademics.in/journals/index.php/ijpps.

INTRODUCTION

The medical field is a noble and exceptional one since it fosters the sacred relationship between patient and doctor since it attempts to bring relief to suffering patients. One of the highest dreams of many school-age children and their parents in India is to pursue a career in Medicine. Additionally, one of the highest-ranked occupations is Medicine because it provides opportunities for both a financially rewarding and socially fulfilling career [1].

To become a successful doctor, one has to be determined to be committed to work for the rest of his life, encounter much long periods of training both basic medical training and specialization training, compromise their personal and family time and must have a commitment towards lifelong learning. The decision to choose medicine as a career for lifetime is, therefore not easy one and not all students who excel in academics may seek entry into medicine [2]. The attitude of society and students toward medical profession and the reason they consider for choosing a particular career are of great importance for policymakers around the world to forecast the future manpower needs of the nation’s health sector [3, 4].

Numerous elements come into play throughout this decision-making process, such as individual interests, peer pressure, self-motivation, financial considerations, choosing a higher quality of life [5]. For the majority of Indian parents, getting their children accepted into a medical school, becoming a doctor, and starting a successful career that brings honours is the Holy Grail [6]. It has been repeatedly observed that many students chose this profession under parental pressure and that a sizeable fraction of them ultimately regret their decisions for a variety of reasons [7-11]. This study was aimed to assess the choice and career aspirations of medical students and their reasons for choosing Medicine as a discipline, among other options. Factors influencing in future specialty selection was evaluated as well.

MATERIALS AND METHODS

This cross-sectional Study was carried out among 1060 willing phase I medical students from all over India after obtaining Institutional Ethical committee clearance (40/IHEC/2020). A structured and validated questionnaire was prepared and was converted into google form questionnaire. Those willing MBBS students from India, who are doing their MBBS course in MCI/NMC recognised institutions were requested to participate in the study. The google form link was sent through social media platform to all possible medical students. The first part of the google form contained details regarding the need for the study, the rights of the participant and the confidentiality of the data. Along with that the informed consent form was attached. Those who were willing to participate continued the questionnaire, while those who were not willing were redirected to submit form option. The questionnaire comprised of both closed and open-ended questions. Except the name and identity, the closed-ended questions the closed-ended questions comprised of socio-demographic variables like age, sex, year of study and the reason for choosing this profession, their current views on choosing the course and if they regret joining the course, the reason for it. Open-ended questions were also added so that the students can give their opinions if there were any.

Statistics

The students’ responses were analysed using SPSS version 27.0. Results were expressed as frequency and percentage. Chi-square test was used to find out the association, if any, between males and females. P value ≤ 0.05 was considered statistically significant for all the results.

RESULTS

The study enrolled a total of 1060 phase I medical students from all over the country. This included 674(63.6%) males and 386(36.4%) females.

The results regarding reasons for choosing medical profession are presented in table 1. Majority (60.4%) expressed passion to serve mankind as the reason for choosing medical profession. This was followed by students having a medical role model (25.8%), social status attached to the profession or prestigious career (25.8%), job opportunity/renumeration/lifestyle (20.8%) in that order. We also explored the gender differences in reasons for choosing medical profession. The female medical students had a significantly higher (66.2%) passion to serve as reason for choosing medical profession compared to males (50.3%). Also, significantly higher number of female students reasoned the parental expectation or pressure for choosing medical profession (18.4%) compared to males (12.4%). On the other hand, significantly higher number of male students reasoned social status attached to the profession or prestigious career (30.3%), wide job opportunity, good renumeration and enjoyable life style (29%) for choosing medical profession compared to females (23.3% and 16.2% respectively). The other reasons did not vary significantly between males and females.

Table 1: Reasons for choosing medical profession

Reasons for choosing medical profession Overall frequency (%) Male’s frequency (%) Female’s frequency (%)

Chisquare

value

 P value
a. Passion to serve 640 (60.4) 194 (50.3) 446 (66.2) 25.979 <0.001**
b. Having a medical role model 273(25.8) 100(25.9) 173(26.7) 0.007 0.942
c. Parental expectations or pressure 172 (16.2) 48 (12.4) 124 (18.4) 6.42 0.012
d. Social status attached to the profession or Prestigious career 274(25.8) 117 (30.3) 157(23.3) 6.305 0.012
e. Wide job opportunity, good remuneration and enjoyable life style 221 (20.8) 112(29) 109 (16.2) 24.534 <0.001
f. Inspired by a medical problem in family 142(13.4) 49 (12.7) 93 (13.8) 0.258 0.640
g. Family owns and runs a hospital 16 (1.5) 8 (2.1) 8 (1.2) 1.295 0.298

(One or more options chosen), **Extremely significant, P value is applied between males and females

We have found that a total of 339(32%), almost one in four, regretted joining the medical profession. The most common reasons why phase I medical students regret joining medical profession were feeling stressed out as there was no time for entertainment and sports activities (19.8%), lifelong learning (14.2%), financial constraints (10.7%) and difficulty with one or more first subjects in that order. None of the reasons varied significantly between the male and female students (table 2).

Table 2: Reasons for regretting medical profession

Reasons for regretting medical profession (n=771) Total frequency (%) Male’s frequency (%) Female’s frequency (%) Chisquare P value
a. Difficulty with one or more first year subjects 108(10.2) 41(10.6) 67(9.9) 0.124 0.752
b. Frequent Assessments 52(4.9) 20(5.2) 32(4.7) 0.099 0.769
Frequent Assignment 43(4.1) 17(4.4) 26(3.9) 0.188 0.747
d. Feeling stressful as there is no time for entertainment or sports activities 210 (19.8) 73(18.9) 137 (20.3) 0.309 0.578
e. Lifelong learning 151 (14.2) 57 (14.8) 94 (13.9) 0.135 0.716
f. Odd working hours 104 (9.8) 40 (10.4) 64 (9.5) 0.209 0.668
g. Financial constraints 103 (10.7) 39 (10.1) 65 (9.5) 0.103 0.829

Regarding students preferred career choices after MBBS, more than half (59.2%) of them preferred doing specialization and super specialization, followed by 17.5% of them were willing to join government service. The preference of other choices namely general practitioner, seeking opportunities abroad, rural service and joining private hospital ranged between 3.3% to 9.2%. we found no statistically significant results between males and females for any of the preferred choices (table 3).

Table 3: Career choice after MBBS

What will be your career choice after MBBS? Overall Male’s frequency (%) Female’s frequency (%) CSV Pvalue
No % No % No %
a. Government service 186 17.5 116 17.2 70 18.1 0.145 0.70
c. General practitioner 60 5.7 43 6.4 17 4.4 1.794 0.18
b. Join private hospital 35 3.3 26 3.9 9 2.3 1.79 0.18
f. Rural service 54 5.1 39 5.8 15 3.9 1.833 0.18
d. Specialisation and Super specialisation 627 59.2 391 58 236 61.1 0.994 0.32
e. Seek opportunities in abroad. 98 9.2 59 8.8 39 10.1 0.533 0.47

Regarding students’ preference for speciality, medicine and related subspecialities (35.4%) were the most preferred, followed by surgical and related sub specialities (22.4%). The basic medical subjects (anatomy and physiology) were the least preferred (0.75). Of particular note we found that 30.5% of the students have not yet decided on their choice of speciality. We did not find any significant difference between males and females regarding preference for speciality except for surgical and related sub specialities and obstetrics and gynaecology significantly higher number of males preferred surgical and related sub specialities (30.6%) and a significantly higher number of females preferred obstetrics and gynaecology (12.6%) (table 4).

Table 4: Preferred speciality for post-graduation

Which speciality would you like to join after completing your graduation? Overall Males Females CSV P value
N % N % N %
Medicine and sub-specialties (Medicine, Paediatrics, Community medicine, Family medicine) 375 35.38 135 34.97 240 35.61 0.043 0.84
b. Surgical and sub specialities (Orthopaedics, ENT, Ophthalmology) 238 22.45 118 30.57 120 17.80 22.97 <0.001
c. Obstetrics and Gynaecology 89 8.40 4 1.04 85 12.61 42.755 <0.001
d. Basic medical subjects (Anatomy/Physiology) 8 0.75 3 0.78 5 0.74 0.004 0.95
e. Laboratory medicine (Biochemistry, Microbiology, Pathology) 11 1.04 2 0.52 9 1.34 1.59 0.21
f. Medical administration/Hospital management 16 1.51 8 2.07 8 1.19 1.3 0.26
g. Not yet decided 323 30.47 116 30.05 207 30.71 0.051 0.82

DISCUSSION

The present study found that passion to serve mankind was the most common reason to choose the medical profession. However, in the subgroup analysis, we found that social status attached to the profession or prestigious career was the most common reason for male medical students to join the profession. Similar to the findings of this study a cross-sectional questionnaire-based survey reported from Chennai India found that almost half of the students joined medical profession because of personal interest and passion for the profession. In a study published from Delhi, “The desire to serve the needy” was the most common reason quoted to become a doctor. These findings probably point towards the attitudinal shift among the current generation of doctors [9-11].

The present study found that almost one in three students regretted joining the medical profession. The most common reason was that they perceived the medical profession to be stressful with no time for entertainment/sports activities. Importantly, this did not differ between male and female students. Similar to the findings of our study, a recent publication documented that one in four students regretted joining the medical profession–three fourth of the students who regretted quoted stress as the primary reason [12]. In a study presented by Jothula et al. [2] almost half (40%) of the students regretted joining medical profession. Though the prevalence was much higher than that reported in the present study, the reasons were similar. In a study published by Seetharaman et al. [8], it was highlighted that the stress associated with medical education is due to parental pressure associated with passing the exams and getting into postgraduation. Also, majority of the students expressed their apprehension towards the longer duration that it usually takes for a medical profession to settle down [2].

The present study found that majority of the students preferred doing specialisation or super specialisation however less than ten percent of the students preferred medical practice (either in the form of being a general practitioner, joining rural service or a private health care facility. This did not differ significantly between male and female students. In a similar study, it was highlighted that around 41% of medical students preferred medicine or its allied speciality subjects. However, the study did not present a gender-related subgroup analysis [13]. Similar preferences towards clinical branches have been reported from various studies from India [14, 15], Pakistan [16], Japan [17], Jordon [18], Trinidad [19] and Turkey [20].

The present study found that medicine and allied specialities are the most preferred, followed by surgical and related sub specialities for post-graduation. The gender-disaggregated analysis showed that male medical students preferred surgical and related sub specialities whereas female medical students preferred obstetrics and gynaecology for post-graduation. It is to be noted that almost one third of medical students have not yet decided on their choice of speciality. Similarly, literature evidence from India document that 70–90% of medical students preferred joining post-graduation following MBBS [12, 13, 21]. The Society and patients believe doctors must be professional hence they expect doctors must have high-quality of education and acquire the necessary skill and will do everything to give them comfort [22]. Covid Pandemic has increased the academic stress on students [23] and the high proportion of regret may due to this.

CONCLUSION

Though passion for the medical profession was the most common reason for coming into this career, parental and few other external influences were also found as the reasons for choosing MBBS among some students. Nearly one-third now regret it because of stress, no time for entertainment/sports and lifelong reading. Counselling sessions, especially for those who are stressed, is the need of the hour. NMC has also rightly pointed out in the new CBME curriculum, the need for a counsellor in all medical colleges.

FUNDING

Nil

AUTHORS CONTRIBUTIONS

Dr. Rashmi contributed in designing of Study, Data Collection and Manuscript writing, Dr. Jeevithan contributed in designing of Study, Data Collection, Data Analysis and Manuscript Writing, Dr. Sridhar contributed in the Conceptualization of Data, Review and edit of the manuscript and Dr. Kalanithi contributed in Conceptualization of Data, Review and edit of manuscript.

CONFLICTS OF INTERESTS

Declared none

REFERENCES

  1. Nath A, Malhotra R, Ingle G, Lal P, Malhotra C. Career aspirations and apprehensions regarding medical education among first-year medical students in Delhi. Indian J Community Med. 2007;32(3):217-8. doi: 10.4103/0970-0218.36835.

  2. Jothula KY, Ganapa P, DS Naidu, NK PA. Study to find out reasons for opting medical profession and regret after joining MBBS course among first-year students of a medical college in Telangana. Int J Community Med Public Health. 2018;5(4):1392-6. doi: 10.18203/2394-6040.ijcmph20180983.

  3. Pruthi S, Pandey R, Singh S, Aggarwal A, Ramavat A, Goel A. Why does an undergraduate student choose medicine as a career. Natl Med J India. 2013;26(3):147-9. PMID 24476160.

  4. Baharvand M, Moghaddam EJ, Pouretemad H, Alavi K. Attitudes of Iranian dental students toward their future careers: an exploratory study. J Dent Educ. 2011;75(11):1489-95. doi: 10.1002/j.0022-0337.2011.75.11.tb05207.x, PMID 22058399.

  5. Huda N, Yousuf S. Career preference of final year medical students of Ziauddin Medical University. Educ Health (Abingdon). 2006;19(3):345-53. doi: 10.1080/13576280600984087, PMID 17178516.

  6. Rani NA, Nusrath A, Dhanalakshmi TA. Medical profession as career-pressure or passion: a cross-sectional survey among undergraduate medical students. Int J Med Sci Educ. 2016;3(4):322-6.

  7. Syakurah RA, Prabandari YS, Widyandana KA, Kumara A. Career choices, determinants, and need for medical career introduction among medical students. Int J Res Med Sci. 2017 May;5(5):1998-2002. doi: 10.18203/2320-6012.ijrms20171832.

  8. Seetharaman N, Logaraj M. Why become a doctor? Exploring the career aspirations and apprehensions among interns in South India. Natl J Res Community Med. 2012;1(4):188-95.

  9. Kumar R, Dhaliwal U. Career choices of undergraduate medical students. Natl Med J India. 2011;24(3):166-9. PMID 21786849.

  10. Odusanya OO, Alakija W, Akesode FA. Socio-demographic profile and career aspirations of medical students in a new medical school. Niger Postgrad Med J. 2000;7(3):112-5. PMID 11257915.

  11. Chang PY, Hung CY, Wang KI, Huang YH, Chang KJ. Factors influencing medical students’ choice of specialty. J Formos Med Assoc. 2006;105(6):489-96. doi: 10.1016/s0929-6646(09)60189-3, PMID 16801037.

  12. Ramya MR, Lakshmi N, Balamurugan P, Nambiar S. Reasons for choosing medical profession as the career among medical college students in Kancheepuram district. Int J Community Med Public Health. 2021;8:412-6.

  13. Sarkar TK, Adhikary M, DV, Jana PK, Rai A, Biswas I. An observational study on career aspiration among students of a medical college in Kolkata. Int J Med Sci Public Health. 2017;6(4). doi: 10.5455/ijmsph.2017.1164815122016.

  14. Gaikwad V, Sudeepa D, Suwarna M. A study on career preferences and attitude towards the rural health services among the graduating interns of a medical college in Bangalore rural. Int J Biol Med Res. 2012;3(2):1577-80.

  15. Gour N, Srivastava D, Adhikari P, Shahi A, Sharma MK, Mahajan PC. Specialty preference among medical students and factors affecting it. Online J Health Allied Sci. 2011;10(2):12.

  16. Rehman A, Rehman T, Shaikh MA, Yasmin H, Asif A, Kafil H. Pakistani medical students’ specialty preference and the influencing factors. J Pak Med Assoc. 2011;61(7):713-8. PMID 22204259.

  17. Saigal P, Takemura Y, Nishiue T, Fetters MD. Factors considered by medical students when formulating their specialty preferences in Japan: findings from a qualitative study. BMC Med Educ. 2007;7:31. doi: 10.1186/1472-6920-7-31, PMID 17848194.

  18. Khader Y, Al-Zoubi D, Amarin Z, Alkafagei A, Khasawneh M, Burgan S. Factors affecting medical students in formulating their specialty preferences in Jordan. BMC Med Educ. 2008;8(1):32. doi: 10.1186/1472-6920-8-32, PMID 18501004.

  19. Baboolal NS, Hutchinson GA. Factors affecting the future choice of specialty among first-year medical students of the University of the West Indies, Trinidad. Med Educ. 2007;41(1):50-6. doi: 10.1111/j.1365-2929.2006.02646.x, PMID 17209892.

  20. Dikici MF, Yaris F, Topsever P, Tuncay Muge F, Gurel FS, Cubukcu M. Factors affecting choice of specialty among first-year medical students of four universities in different regions of Turkey. Croat Med J. 2008;49(3):415-20. doi: 10.3325/cmj.2008.3.415, PMID 18581621.

  21. Giri PA, Sambutwad RC, Kausar HM, Muneshwar SN, Shafee M. Career choices regarding medical education among first-year medical students of IIMSR Medical College, Badnapur, Jalna, Maharashtra, India. Int J Community Med Public Health. 2015;2:620-3. doi: 10.18203/2394-6040.ijcmph20151058.

  22. Salam A, Haque M, Islam Z, Helali A, Yousuf R, Yesmin F. Comparative study of professionalism of future medical professionals among three private Medical colleges of Bangladesh. Asian J Pharm Clin Res. 2013;6(3):170-9.

  23. Adetunji B. Implications of coronavirus disease-19 on clinical clerkship and hospital postings. Innovare J Med Sci. 2021;9(5):1-2. doi: 10.22159/ijms.2021.v9i5.39666.