Choosing Psychiatry as a Career: Motivators and Deterrents at a Critical Decision-Making Juncture

Recruitment to psychiatry residency positions remains a challenge across Canada,1 the United States,2 and internationally,3 with positions leftunfilled in national residency matching programs each year. Given the estimates of societal need,4 residency training programs, medical schools, and health service planners must better understand and respond to the determinants of medical students' decisions to enter residency training in psychiatry. Current literature highlights several contributors to the recruitment challenge, including medical and pre-medical school influences, financial imperatives, patient and discipline stigma, and lifestyle implications.5 The psychiatry recruitment literature largely includes retrospective perspectives of current psychiatry resident trainees and junior undergraduate medical students earlier in their training.6-8To enhance the understanding of career decision-making processes and contribute to a comprehensive recruitment strategy, we surveyed applicants to the University of Toronto Psychiatry Residency Program who participated in the 2012/2013 CaRMS Residency Program Orientation and Interview activities. Applicants were surveyed immediately following the residency program ranking submission deadline, to probe a cross-section of perspectives immediately proximal to the decision-making window for trainees. Given that applicants to psychiatry residency programs do not ultimately exclusively rank psychiatry programs, the goal was to better understand the influences on final ranking decisions.MethodsIn March 2013, an online self-report survey was sent to all (n = 111) University of Toronto Psychiatry Residency Program applicants applying through CaRMS. Applicants were surveyed shortly after the ranking preference submission deadline for applicants and programs but prior to the match date or announcement of residency position assignments by CaRMS. This post-ranking submission and pre-match results day survey window was explicitly chosen to minimize undue concern about participation impacting program ranking decisions, elicit feedback proximal to the medical students' reflective process regarding ranking choices, and eliminate potential bias related to the psychological impact of the actual match result. Participation was voluntary and anonymous. The University of Toronto PGME Office provided research design support and the University of Toronto Research Ethics Board provided research ethics approval.Survey questions (Table 1) were informed by themes from existing literature and by feedback provided by applicants in pilot surveys from 2 previous cycles of postmatch applicant surveys. Consequently the questions were designed to probe the following key potential impacts on selecting psychiatry for residency: psychiatry-specific exposure, information-interview day experience, residency program features, discipline and patient-related stigma, and unique aspects of psychiatric practice, compared with other disciplines.ResultsSixty (n = 60) respondents participated in the survey (54% response rate), with 97% (n = 58) of respondents completing all questions. Descriptive statistics and narratives were used to interpret the responses.Motivators and DeterrentsRespondents identified the emphasis of neuroscience, diagnostic complexity, patient stigma, and the favourable job market for psychiatry as motivating factors in choosing a career in psychiatry. Conversely, factors such as discipline stigma among colleagues and residency program length were rated as deterrents from choosing a psychiatry residency (Table 2).Insufficient elective time exposure to both psychiatry itself and to psychiatry programs at specific universities was identified as a barrier to selecting psychiatry. Applicants indicated that earlier exposure to mental health careers, psychiatry residents, and psychiatry faculty during medical school were key factors in aiding career explorations and ranking decisions. …