Physicians' Career Choices and Entering Academic Medicine

Preparation and Experience Shaping Physicians’ Career Choices

Physicians’ career choices unfold through medical school admission, specialty selection, the choice of a training institution, and workplace transitions after training. This process involves interests, aptitudes, and lifestyle preferences, as well as work experiences, advice from others, available positions, and opportunities for growth. Academic medicine combines education, research, and patient care. It requires an interest in research along with the time and resources to fulfill multiple roles. Understanding physicians’ career development requires examining both how individuals prepare to make decisions and the experiences and working conditions that educational and training institutions provide.

Career Maturity and Difficulties in Specialty Selection

A study of medical students’ career preparation used the Career Maturity Inventory (CMI) and the Specialty Indecision Scale (SIS) to distinguish readiness to make career decisions from difficulties in selecting a specialty (Lee et al., 2022). The research team conducted an online survey of 600 medical students in years 1 to 4 at Seoul National University College of Medicine from December 2020 to July 2021. The methods section and analysis tables report a sample of 181 (30.2%), while the abstract and results sections list 198 completed surveys. The analysis sample comprised 68, 64, 24, and 25 students in successive years. In a cross-sectional survey comparing year cohorts, the research team used 24 items from the CMI Counseling Form-C and 35 items from a version of the SIS that they had translated, with both instruments using a 5-point Likert scale. Following principal component analysis with varimax rotation, the CMI was refined to 13 items across 4 factors and the SIS to 17 items across 6 factors. These accounted for 59.8% and 73.0% of the variance, respectively. Higher CMI scores indicate greater career maturity, whereas higher SIS scores indicate greater difficulty. Higher scores on SIS Readiness indicate a lack of preparation.

On the CMI, Confidence differed significantly by year, with a mean of 2.81 for year 1 and 3.22 for year 4. Post hoc testing showed that scores for year 1 were lower than those for years 2 and 4 (P = 0.035). Mean SIS Readiness scores were 3.23 for year 1 and 2.54 for year 4, with year 1 scores indicating less preparation than those for year 3 (P = 0.007) and year 4 (P = 0.001). Information and Indecisiveness had the highest mean scores in year 3, and Self-doubt increased across successive years. Differences by year in these domains were not statistically significant. Negative correlations were observed between Curiosity and Information (r = −0.622) and between Confidence and Indecisiveness (r = −0.475) (both P < 0.01). Multiple regression analysis also identified significant relationships, with positive associations reported for Concern–Self-doubt and Consultation–Barriers. The simple correlation for Concern–Self-doubt was −0.318. This association requires separate interpretation from the regression results, which account for other variables simultaneously.

The study proposed differentiated support addressing awareness of career planning, identity-related difficulties, specific career information, and in-depth counseling and coaching. Interpretation also depends on the small number of year 3 and 4 participants, the cross-cultural validation of the Korean version of the SIS, and the measurement scope of the refined items.

From Medical School Admission to Post-Training Workplace Selection

Retrospective interviews with physicians in the Daejeon, Sejong, and Chungcheongnam-do region examined factors influencing career choices (Lee & Kim, 2025). The research team recruited physicians with 5 or more years of experience who had graduated from medical schools in the region or were working there. Recruitment used purposive sampling based on alumni association recommendations and snowball sampling through professional networks. The participants included 7 men and 3 women with 6 to 26 years of experience, encompassing employed physicians, clinic owners, professors, and public officials. Individual interviews lasting about 1 hour each were conducted at participants’ workplaces from February 21 to March 9, 2023. The study reported reaching thematic saturation after 10 interviews. For one participant who declined recording, the researchers analyzed responses to a preliminary questionnaire and researcher notes. Two researchers independently analyzed and cross-checked the data using the constant comparative method. Factors influencing career choices were organized into 3 categories, 7 themes, and 18 sub-themes.

Career paths in clinical medicine progressed through residency training, subspecialties, graduate school, and fellowships to workplace selection. Paths in basic medicine generally led to graduate school. Family environment and recommendations from close associates were frequently mentioned in accounts of medical school admission. All participants identified interest, aptitude, and personality as major factors in specialty selection after graduation. Many used a ‘rule-out’ method to exclude unsuitable specialties. During training, choices were influenced by dependable senior colleagues, team atmosphere, available positions, and opportunities to develop competencies and expand professional networks. When selecting a workplace after training, interest and passion were mentioned 4 times, while senior colleagues or professors and lifestyle were each mentioned 3 times. Selection criteria encompassed professorships that drew on participants’ expertise, policy work with clear goals, and workplaces that allowed adjustments to the demands of caring for emergency and severely ill patients.

Accounts of careers in academic medicine indicated that participants had not fully understood the educational and research roles of a university hospital professor. Some had expected a professor’s life to be more relaxed than it proved to be. The study proposed supporting self-exploration in BME and considering organizational culture and growth opportunities in graduate medical education (GME). It also proposed incorporating information about job duties, working environments, and compensation into mentoring in GME and CPD. Movement between regional universities and hospitals was viewed as part of career growth, and the study presented a career development network. How frequently factors were mentioned in the retrospective accounts of 10 participants reflects how they explained past choices from the perspective of their current careers, rather than the influence of each factor. The sampling context also matters: all participants except the public official came from the same medical school.

The Relationship Between Research Interest and Academic Medicine Career Intentions

A study examining intentions to enter academic medicine applied Social Cognitive Career Theory (SCCT) to analyze individual cognition alongside the training environment (Deledalle et al., 2026). The final analysis included 1,570 French residents recruited through social media and email. The sample comprised 997 women (63.5%) and 573 men (36.5%), with a mean age of 27.28 years. The research team measured intention to pursue a career in academic medicine using a single 5-point item. Research interest was measured using the 8 items of the Interest subscale of the Attitude toward Research Scale. General self-efficacy was measured using the 10 items of the General Self-Efficacy Scale. Outcome expectations were operationalized using 5 items on work centrality, reflecting the meaning, identity, and value derived from work. The survey also assessed stress, academic satisfaction, research degree experience, and the presence of a mentor. The cross-sectional data were analyzed using hierarchical ordinal regression and structural equation modeling, with multigroup analyses by gender and research experience.

Responses of 4–5, indicating a strong intention to pursue academic medicine, accounted for 20.1% of the total, with rates of 15.1% for women and 28.8% for men (χ² = 41.33, p < .001). In the final regression model controlling for gender, research interest was the strongest predictor (OR = 4.9, confidence interval 4.2–5.7). Relative to the group with no research experience, the odds ratios were OR = 2.0 for M1 and OR = 3.7 for M2 or PhD. Having a mentor was associated with OR = 1.3. Work centrality was directly related to career intention (OR = 1.5), but the direct relationships for general self-efficacy, stress, and academic satisfaction were not significant. The odds ratio for women compared with men was 0.6 and remained significant in the final model. Fit indices for the structural equation model were CFI = 0.93, TLI = 0.92, RMSEA = 0.04, and SRMR = 0.04. Work centrality (β = 0.34) and self-efficacy (β = 0.05) were positively related to research interest. In the M2 and PhD groups, the relationship between work centrality and research interest was β = 0.47 for men and β = 0.33 for women.

The proportion with M2 experience was 26.4% for men and 17.6% for women, and 44.5% of men and 38.5% of women reported having a mentor. The study proposed early structured research experiences, dedicated research time, support for master’s and doctoral programs, and institutional mentoring. Because research experience, interest, and intention were surveyed at the same time point, interpretation of these findings requires considering both how interest develops through experience and how existing interest guides the selection of experiences. Open recruitment and the absence of a response rate also shape interpretation of the sample. Career intention reflects an attitude preceding actual entry and employment.

Organizational Support Sustaining Education, Research, and Clinical Care

A review of academic medical centers (AMCs) examined financial and personnel data and examples of innovation at US AMCs (An, 2019). Patient-centered value is presented as an operational standard for allocating resources across education, research, and clinical care and for evaluating collaboration among members. In the US medical school financial data cited in the review, the proportion of public funding decreased from 58% in 1961 to 30% in 2009, while the proportion of clinical revenue increased from 6% to 52%. The share of faculty duties devoted to clinical work also increased from 23% in 1984 to 40.7% in 2001, whereas the share devoted to research decreased from 29% to 14.7%. In South Korea, 81% of hospitals with educational functions were described as private medical institutions relying primarily on clinical revenue. This provided context for the relationship between clinical workload and resources for education and research.

Institutional responses included improvements in patient care processes and structural changes to support collaboration. Since 2006, Geisinger’s ProvenCare has charged no additional fees for readmissions within 90 days after coronary artery bypass grafting. The review described reductions in medical costs, hospital stays, and readmission rates. Following the Cleveland Clinic’s post-2014 improvements in cancer care, the median time from diagnosis to treatment initiation decreased from 41 to 31 days for externally referred patients and from 25 to 21 days for internally referred patients. These improvements involved identifying causes of delay and sharing team performance data without adding personnel. Vanderbilt’s Numbers Day and Johns Hopkins Medicine’s financial reporting illustrate operational practices for reviewing missions alongside investment priorities. communicate with H.E.A.R.T connected patient-centered values to daily tasks through training involving multiple professions.

Measures supporting academic careers addressed funding, relationships, and evaluation systems. The University of California, San Diego’s junior faculty development program involved 120 of 839 newly appointed faculty members from 1998 to 2005. Participants had a significantly lower attrition rate. Weill Cornell Medicine invested $1.6 million in early research funding, annual research retreats, and monthly mentoring seminars from 2013 to 2017. The review linked this investment to the receipt of $4.2 million in external research grants. The review also described appointment and promotion evaluations that recognize curriculum design and textbook development, student participation in research and MD-PhD programs, and support through scholarships and debt repayment. Taking institutional differences between the US and South Korea into account, the review discussed how research time, funding, mentoring, and career portfolios support entry into basic medicine and the development of junior faculty in South Korea.

Reading notes

The differences by year in CMI and SIS scores reflect responses from different student cohorts. The relationships between scales are based on self-reports at a single time point. These findings describe cohort differences and concurrent associations rather than individual development or counseling effects. General self-efficacy and work centrality measure constructs distinct from confidence in conducting research and expectations for research outcomes, respectively. Research from an HRD perspective could use a single study design to track interest and self-efficacy before and after research participation and link them to the support provided by mentors, actual working hours, and subsequent career choices.

References

• Lee, S.-Y., & Kim, J. L. (2025). Career paths and career choice factors of medical school graduates working in the Daejeon, Sejong, and Chungcheongnam-do region: A retrospective observational study. Korean Journal of Medical Education, 37(2), 105–118. https://doi.org/10.3946/kjme.2025.328
• Lee, S.-y., Lee, M.-j., & Lee, S.-H. (2022). Analysis on students’ career preparation in one Korean medical school: Based on the relationship and trend between career maturity and specialty indecision. Journal of Korean Medical Science, 37(37), e277. https://doi.org/10.3346/jkms.2022.37.e277
• Deledalle, A., Bour, V., Galharret, J.-M., Sarda, É., Gourraud, P.-A., Cohen, F., Lemarchand, P., & Congard, A. (2026). Academic medicine career intentions among medical residents: A social cognitive career theory approach. BMC Medical Education, 26(1), 1405. https://doi.org/10.1186/s12909-026-09740-4
• An, S. (2019). Academic medicine is patient-centered medicine. Korean Medical Education Review, 21(2), 80–91. https://doi.org/10.17496/kmer.2019.21.2.80