J Korean Med Sci.  2024 Jul;39(29):e211. 10.3346/jkms.2024.39.e211.

Barriers to Choosing Pediatrics as a Specialty: Insights From a CrossSectional Analysis

• Yoo HH
• You J

• KMID: 2558248
• DOI: http://doi.org/10.3346/jkms.2024.39.e211

Abstract

Background
The pediatric field in South Korea is experiencing a significant workforce crisis due to a sharp decline in pediatricians, exacerbated by a decrease in pediatric residents and a series of distressing incidents in pediatric healthcare institutions. No prior studies have explored the waning interest in pediatrics among South Korea’s medical students and interns, which our research seeks to address during a pediatric workforce decline. This study aimed to investigate the declining interest in pediatrics among medical students and interns in South Korea amidst decreasing birth rates. We conducted a comprehensive survey to identify the factors deterring young medical professionals from pursuing a career in pediatrics.
Methods
In this cross-sectional study, in December 2023 we surveyed medical students and interns at Jeonbuk National University and Hospital using a 40-item electronically distributed questionnaire tailored to assess the factors influencing specialty choice, focusing on pediatrics. The participants were divided into the pre-clinical and clinical groups, allowing for analysis across educational stages. The survey covered demographics, perceptions of pediatrics, attitudes toward medical errors, and awareness of critical issues; it included a range of question types to ensure detailed and nuanced data collection.
Results
Our findings revealed a clear decrease in interest in pediatrics as medical students progressed through their education, with 86.69% displaying negative views. Although a sense of mission and emotional satisfaction from patient interactions were highlighted as positive influences, they were significantly countered by worries related to declining pediatric populations, legal challenges, and interactions with patient guardians. Additionally, 95.84% of the participants recognized the critical role of vital pediatric departments; however, litigation risks and psychological burdens substantially affected their willingness to specialize in these areas. The analysis also showed an increasing awareness of pediatric incidents as students advanced through their education; however, this did not directly correlate with their choice of specialty (P = 0.090).
Conclusion
The results emphasize the necessity for targeted interventions to alleviate concerns and improve the attractiveness of pediatrics. These efforts are essential to counteract the declining interest and ensure a sustainable pediatric workforce for the future.

Keyword

Pediatrics; Specialty Choice; Medical Students; Interns

Figure

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  Fig. 1 Distribution of medical students’ interest in pediatrics based on academic year and internship stage. 1 = strongly disagree; 2 = disagree; 3 = somewhat disagree; 4 = somewhat agree; 5 = agree; 6 = strongly agree.

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  Fig. 2 Medical students’ perceptions and considerations for pediatrics across educational stages: a heatmap analysis. (A) Heatmap of medical students’ positive perceptions towards pediatrics based on educational stages: 1) Income level, 2) work hours and life balance, 3) emotional satisfaction from interacting with pediatric patients, 4) sense of mission in improving the health and welfare of pediatric patients, 5) optimism for future development due to current medical staff shortage, 6) professional achievement in restoring health and life of pediatric patients, 7) positivity of pediatric patients’ recovering ability and prognosis, and 8) academic exploration of pediatrics and pediatric patients. (B) Heatmap of medical students' negative perceptions towards pediatrics based on educational stages: 1) Income level, 2) work hours and life balance, 3) decrease in the pediatric population due to a very low birth rate, 4) difficulties in interacting with guardians, 5) complexity and difficulties in interacting with pediatric patients, 6) influence of mass media, 7) employment insecurity, 8) anxiety about frequent life-threatening situations in pediatrics, 9) anxiety about lawsuits, 10) uncertainty in duty and future career as a specialist, 11) decreased academic attraction to pediatrics and pediatric patients, and 12) professional stress and anxiety from competition with general practitioners. (C) Heatmap of medical students’ perceptions and required improvements for choosing pediatrics based on educational stages: 1) Legal security measures against lawsuits, 2) economic stability from increased compensation, 3) job opportunities and career growth due to job increase, 4) increased pediatric medical demand and job security from higher birth rates, 5) hiring of professional guardian consultants, 6) enhanced respect and job satisfaction from improved social perception, 7) improvement in workload distribution due to a shortage of pediatric staff, and 8) unique procedures or treatments exclusive to pediatric specialists.

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  Fig. 3 Medical students’ awareness of significant pediatric incidents based on educational stages. (A) Awareness levels of medical students regarding the Ewha Womans University Mokdong Hospital neonatal incident. 1 = first time hearing; 2 = informed; 3 = moderately informed; 4 = well informed; 5 = very informed; 6 = very well informed. (B) Medical students’ awareness of the croup pediatric death incident. 1 = first time hearing; 2 = informed; 3 = moderately informed; 4 = well informed; 5 = very informed; 6 = very well informed. (C) Medical students’ awareness of the Declaration of Pediatrics Department Closures. 1 = first time hearing; 2 = informed; 3 = moderately informed; 4 = well informed; 5 = very informed; 6 = very well informed.

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  Fig. 4 Perspectives of medical students on the distribution of intensive care units for neonates and children. (A) Opinions on the necessity of NICUs. A NICU should be mandatory in every hospital; one NICU per city with a population of over 200,000 people and one NICU per autonomous province. NICUs are only necessary in metropolitan cities. (B) Opinions on the necessity of PICUs. A PICU should be mandatory in every hospital; one PICU per city with a population of over 200,000; one PICU per autonomous province; PICUs are only necessary in metropolitan cities.NICU = neonatal intensive care unit, PICU = pediatric intensive care unit.

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  Fig. 5 Influence of various factors on challenges faced by medical students in choosing a vital department. Litigation risk, psychological burden, social perception, knowledge update, staff shortage anxiety.

Reference

1. The Korean Pediatric Society. Updated 2022. Accessed January 19, 2024. https://www.pediatrics.or.kr/bbs/index.html?code=notice&category=&gubun=&page=1&number=13473&mode=view&keyfield=&key= .

2. The Korean Society of Neonatology. Updated 2018. Accessed January 19, 2024. https://www.neonatology.or.kr/ .

3. The Supreme Court of Korea. Decision on Citrobacter Freundii Infection Leading to Fatal Septicemia. Updated 2022. Accessed April 23, 2024. https://judges.scourt.go.kr/portal/news/NewsViewAction.work?seqnum=4784&gubun=2&searchOption=&searchWord=# .

4. Kim J. In an era of low birth rates, support measures for children and adolescents in crisis. Med Policy Forum. 2023; 20(4):48–53.

5. Ministry of Health and Welfare. Updated 2023. Accessed January 20, 2024. https://www.mohw.go.kr/board.es?mid=a10504000000&bid=0030&cg_code= .

6. Ye RM, Choi YH. Analysis of pediatric emergency medical use and resource changes and medical accessibility. Updated 2023. Accessed May 23, 2024. https://repository.hira.or.kr/handle/2019.oak/3209 .

7. Woo BS. Essential medical crisis and medical school capacity. Med Policy Forum. 2023; 21(2):3–6.

8. The Korean Pediatric Society. Updated 2023. Accessed January 20, 2024. https://www.pediatrics.or.kr/bbs/index.html?code=notice&category=&gubun=&page=1&number=13931&mode=view&keyfield=all&key= .

9. Khamees A, Awadi S, Al Sharie S, Faiyoumi BA, Alzu’bi E, Hailat L, et al. Factors affecting medical student’s decision in choosing a future career specialty: a cross-sectional study. Ann Med Surg (Lond). 2022; 74:103305. PMID: 35145673.

10. Al-Beitawi SN, Al-Shatanawi TN, Qudsieh SA, Abu Marar EI, Al Zoubi MS, Al-Zubi M. 6th year medical students’ future specialty preferences: a cross-sectional study. Ann Med Surg (Lond). 2021; 66:102373. PMID: 34040768.

11. Alawad AA, Khan WS, Abdelrazig YM, Elzain YI, Khalil HO, Ahmed OB, et al. Factors considered by undergraduate medical students when selecting specialty of their future careers. Pan Afr Med J. 2015; 20:102. PMID: 26090050.

12. Smith F, Lambert TW, Goldacre MJ. Factors influencing junior doctors’ choices of future specialty: trends over time and demographics based on results from UK national surveys. J R Soc Med. 2015; 108(10):396–405. PMID: 26432808.

13. Roberts C, Vick D, Oakley J. G198(P) Students’ perceptions of paediatrics and the impact of a careers workshop. Arch Dis Child. 2020; 105(Suppl 1):A70–A71.

14. Kahvo M, Whelan R, Vallabhaneni P. Why choose paediatrics? A scoping review of factors affecting the choice of paediatrics as a career. Eur J Pediatr. 2023; 182(1):9–23. PMID: 36316579.

15. Balmer DF, Gottlieb-Smith RJ, Hobday PM, Long M, Carraccio C, Bale JF, et al. Pediatric career choice: insights from a novel, medical school pathway program. Acad Pediatr. 2020; 20(1):97–103. PMID: 31404708.

16. Amudhan AS, Palaniyandi A, Rajan M, Parthiban P, Rajendraprasath S, Saminathan T, et al. The Driving factors important for evaluation student’s opinion which influenced decision making of career choice: pediatrics as a career choice as an example. Acta Inform Med. 2021; 29(2):94–98. PMID: 34584330.

17. Shortland D, Roland D, Lumsden DE, Ewing C, L’Esperance V, McColgan M, et al. Career intentions and choices of paediatricians entering training in the UK. Arch Dis Child. 2015; 100(6):537–541. PMID: 25538188.