What Do Future (Female) Pediatricians Value?
Article Outline
Abbreviations: AAMC, Association of American Medical Colleges, CiM, Careers in Medicine, PVIPS, Physician Values in Practice Scale
There are deep concerns about an inadequate supply of future academic pediatricians and pediatric subspecialists.1, 2, 3, 4 It is hoped that, by better understanding the professional values that impact career choice of medical students and pediatrics residents, we could more effectively address workforce shortages5, 6 in pediatric subspecialties.
One of the remarkable demographic shifts in medicine over the last 2 decades has been the steady increase of female medical students and pediatric trainees.7 Yet, we know very little about the professional values of future pediatricians and whether there are significant differences in values by sex.8 The purpose of this study was to define the values of medical students in relation to medical specialty choice and sex.
Methodology
The study participants included recently graduated medical students registered to use the Careers in Medicine (CiM) Web site, operated by the Association of American Medical Colleges (AAMC).9 CiM is a comprehensive career planning program available to students from all U.S. and Canadian medical schools. The site contains online career assessment resources and specialty information to help medical students choose their residency. The participants selected for this study had been in residency training for 2 years or less.
The Physician Values in Practice Scale (PVIPS) is a measure of personal values related to the practice of medicine.8 This 35-item inventory was developed for and validated on medical students from U.S. medical schools. The PVIPS helps students identify what is most important to them about being a physician and which aspects of the profession they find the most personally satisfying. It measures 6 important values: Prestige (the desire to be recognized by others as a top physician), Service (the desire to care for others regardless of financial gains or other rewards), Autonomy (the importance of freedom, independence, and control over clinical decision making), Lifestyle (a desire for a predictable and stable work schedule), Management (the desire to supervise and have responsibility for others), and Scholarly Pursuits (the desire to engage in clinical or basic research and scholarship activities, academic medicine, and teaching).
The PVIPS reports reliability estimates ranging from .77 to .88 with an overall Cronbach’s alpha coefficient of .83.10 Each question begins with the statement “In my medical career it will be important that I
….” The questions are rated using a Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). The PVIPS is administered online as part of the CiM career planning service of the AAMC.
The PVIPS results were obtained from the CiM Web site for medical students who had completed the survey before graduation and begun residency training within the previous 2 years. The participants were assigned to 1 of 2 groups on the basis of area of specialization chosen. Because the AAMC tracks residency choice in a number of medical disciplines (including pediatrics), students who selected pediatrics were assigned to 1 group, and “all other” students were assigned to the second group consisting of the remaining residencies (psychiatry, surgery, obstetrics-gynecology, internal medicine, and family medicine). Demographic data were collected from both groups.
Analysis
Two multivariate analyses of variance were conducted to assess differences between the pediatrics resident group and the “all other” group, followed by an analysis of differences between male and female pediatric students who entered pediatric residency.
Results
Of the 3328 residents in the study (45% male and 55% female), 350 (10.5%) belonged to the pediatrics group, and 2978 (89.5%) were assigned to the “all other” group. As shown in the Table (available at www.jpeds.com), pediatrics residents scored significantly higher than other residents on Service, and lower on Autonomy, Management, and Prestige. No differences were found between these groups in the Lifestyle and Scholarly Pursuits categories.
Table. Mean PVIPS Scale scores, pediatrics residents vs all other residents
| Pediatrics residents⁎ | All other residents† | Total‡ | |
|---|---|---|---|
| Autonomy§ | 3.69±0.43 | 3.8±0.44 | 3.79±0.44 |
| Lifestyle | 3.42±0.76 | 3.41±0.83 | 3.41±0.83 |
| Management | 2.5±0.62 | 2.58±0.63 | 2.57±0.63 |
| Prestige§ | 2.89±0.65 | 3.17±0.67 | 3.14±0.68 |
| Scholarly Pursuits | 2.57±0.85 | 2.66±0.86 | 2.65±0.86 |
| Service§ | 3.57±0.58 | 3.36±0.62 | 3.38±0.62 |
§Denotes values that were significantly different between groups. Autonomy (F = 10.410, df = 1, P < .001) and Prestige (F = 34.551, df = 1, P < .001) were significantly less important, whereas Service (F = 22.747, df = 1, P < .001) was significantly more important to future pediatricians. |
⁎n = 350. |
†n = 2978. |
‡n = 3328. |
In the second analysis, we examined sex differences in the values of residents belonging to the pediatrics group and the “all other” group. The pediatrics group yielded a total of 350 participants, with 27% men and 73% women, and the “all other” group was comprised of 47% men and 53% women. Among future pediatricians, significant differences were found between men and women on all values except Management, with men scoring higher on the values of Autonomy, Prestige, and Scholarly Pursuits, and women scoring significantly higher on Lifestyle and Service (Figure 1; available at www.jpeds.com). The largest variation in values between sexes was found in Scholarly Pursuits. Among the “all other” group, significant differences were found between men and women on all values except Lifestyle, with men scoring higher on the values of Autonomy, Management, Prestige, and Scholarly Pursuits, and women scoring significantly higher on Service (Figure 2; available at www.jpeds.com). Women in both the pediatrics group and the “all other” group value Service to a greater extent than their male counterparts. Furthermore, both groups of female trainees place significantly lower emphasis on the value of Scholarly Pursuits as compared with male trainees. However, in the pediatrics group, women scored significantly higher than men on Lifestyle, even though there was not a statistically significant difference between men and women from the “all other” group on the value of Lifestyle.
Figure 1.
Values of students training in pediatrics. Comparing average PVIPS scale scores by gender shows statistically significant differences in values of Autonomy (P < .05), Lifestyle (P < .05), Prestige (P < .05), Scholarly Pursuits (P < .001), and Service (P < .05). Values in which significant differences were found, men tended to score higher than women on Autonomy, Prestige, and Scholarly Pursuits, although women scored higher on Lifestyle and Service.
, male; 
, female; —♦—, total.
Figure 2.
Values of students training in all residencies excluding pediatrics. Comparing average PVIPS scale scores by gender shows statistically significant differences in values of Autonomy (P < .001), Management (P < .001), Prestige (P < .001), Scholarly Pursuits (P < .01), and Service (P < .001). Values in which significant differences were found, men tended to score higher than women on Autonomy, Management, Prestige, and Scholarly Pursuits, although women scored higher on Service.
, male; , female.
Discussion
Our study examined values in medical students in relation to medical specialty choice and sex. Although our sample size of medical students choosing pediatrics was relatively small and could have introduced bias to the analyses, it was representative of the relative number of women in pediatrics training programs (73% of respondents were women vs 70% of pediatric residents were women in 2002).11 The analyses of values data by career choice and sex uncovered highly significant differences discussed below.
Autonomy was the top-ranked value overall among medical students. Although women in pediatrics placed somewhat lower importance on Autonomy relative to male counterparts, medical professionals clearly value their freedom, independence, and control over clinical decision making.
After Autonomy, the values of Service and Lifestyle were most important to male and female respondents from both groups. Students selecting pediatrics training placed significantly higher value on Service, that is the desire to care for others regardless of financial gains or other rewards, and women rated it significantly more important than men. Although lifestyle was regarded highly by all residents, regardless of specialty, women in the pediatrics group rated it significantly higher than men in pediatrics. These data are consistent with the view that women may be somewhat more conflicted with the responsibility of being a physician and the future added responsibility of starting a family.5 Moreover, pediatrics trainees did not think that the desire to be recognized by others as a top physician (Prestige) was as important as trainees in other disciplines.
It is perhaps not surprising that Management issues were of least importance across the board, given that undergraduate medical education and residency training generally do not devote substantial attention to the intricacies of healthcare business.12 However, in view of the importance of such concerns in all specialties, it would be appropriate for newly graduating physicians, including pediatricians, to be concerned about these issues. Experienced practitioners who have entered private practice or group practice with no training in management have had to learn the hard way how to run a business, hire and fire, and work several days a week to support the office overhead before they start earning for themselves.12
Although most medical students have been taught primarily in academic settings and are continually exposed to scholarship, they ranked Scholarly Pursuits second to last overall and third among students entering pediatrics residency. These findings are of concern with regard to the pipeline for academic medicine and academic pediatrics, particularly among female trainees. It may be that current role models underestimate the importance of scholarship in academic environments that stress clinical quotas over publications.13, 14 The low numbers of women in academic leadership roles also confounds the perceptions of our students, especially among female students.11, 15 Additional research is needed to better understand why scholarship is so relatively unimportant to students, particularly among women who have selected pediatrics as careers. In addition, because candidates for all pediatric subspecialty training may be increasingly female, the lower value for Scholarly Pursuits may have significant workforce implications for the future of academic pediatrics.
One proposed strategy to enhance the value of scholarship might be to link scholarly activities more closely with high-ranked values such as Autonomy, Lifestyle, and Service. Mentors may be most effective as role models13 by demonstrating a passion for their work and connectivity between autonomy and scholarship, for example. The national emphasis on enhancing clinical and translational research creates a platform for mentors to demonstrate how patient care (Service) is inextricably linked to science (Scholarly Pursuits) by moving discoveries from the bench to the clinic, and then to the community. Evidence suggests that physicians entering academic medicine with mentors are more likely to have productive careers in research in addition to reporting an overall higher level of career satisfaction.16, 17 With the guidance of a mentor, perhaps medical students entering pediatrics training programs can realize the rewards of conducting research and publishing studies in peer-reviewed journals.17 The ability to convey compassion and be an excellent teacher in academic pediatrics may be increasingly important to getting the attention of promising young investigators who may desire a more predictable and stable work schedule than previous generations of trainees.
Next Steps
The focus of this report has been on values and sex, with emphasis on differences in students who select pediatrics careers. It is important to note that the duty to nurture new pediatricians rests primarily with Silent (born before 1946), Baby Boomer (born 1946-1964), and Generation X (born 1964-1980) mentors and advisors, who may have significantly different values than the medical students.1, 18 These generational differences must be characterized, acknowledged, and understood to foster career development of the next generation of pediatricians and to address workforce shortages in pediatric neurology and other disciplines.
Acknowledgments available at www.jpeds.com.
References available at www.jpeds.com.
The authors would like to thank Dr. John B. Molidor from Michigan State University for bringing awareness to generational differences in values and Dr. Paul J. Hartung from Northeastern Ohio Universities College of Medicine for encouraging use of the Physician Values in Practice Scale in the study.
References
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PII: S0022-3476(07)00655-5
doi:10.1016/j.jpeds.2007.07.001
© 2007 Mosby, Inc. All rights reserved.
