Career paths and career choice factors of medical school graduates working in the Daejeon, Sejong, and Chungcheongnam-do region: a retrospective observational study
Article information
Abstract
Purpose
This study analyzed the career paths of medical school graduates in the Daejeon, Sejong, and Chungcheongnam-do (DSC) region of South Korea, focusing on career choice factors at each career path. The ultimate goal was to derive practical insights to improve career guidance in the medical field and enhance professionalism.
Methods
Data were collected through in-depth interviews with 10 medical school graduates working in the DSC region. A semi-structured questionnaire was used to explore their career paths, and factors influencing their career decisions. The collected qualitative data were analyzed using the constant comparative method to identify themes and categories.
Results
The study results categorized career stages into three phases: “entering medical school,” “choosing a specialty after graduation,” and “choosing a workplace after training.” Career choice factors were classified into “personal factors,” “social factors,” and “job and work environment factors.” The factors influencing career choices differed across each career path.
Conclusion
This study holds significance in its in-depth analysis of career choice factors across different career paths from a long-term perspective. The findings suggest that effective support for career decision-making in the medical field requires a tailored approach that considers the distinct needs and influencing factors at each career path.
Introduction
The career choices of medical school graduates influence not only their individual professional achievements but also the overall quality of healthcare services. A clear trend in Korea and globally is the reluctance to choose less popular specialties. This has led to societal issues such as regional imbalances with respect to medical professionals and gaps in essential medical fields [1,2]. Although research on medical careers has been conducted in Korea, most studies have focused on the factors influencing specialty choices among medical students [3-9]. Additionally, some studies have focused on individual personality differences as career selection factors [6,9]. Consequently, there is a lack of in-depth research examining the career choices of medical school graduates from a comprehensive and long-term perspective. It is necessary to analyze the factors influencing career decisions among medical school graduates to provide foundational data for future career support strategies for medical students and graduates.
Kim et al. [4] classified the factors influencing specialty choices into three categories: “personal,” “specialty,” and “socioeconomic.” Harris et al. [10] categorized these factors into “extrinsic” and “intrinsic.” Subcategories under “extrinsic factors” include “work culture typical of the specialty,” “opportunity to work flexible hours,” “experience as a medical student,” and “type of patients.” However, subcategories under “intrinsic factors” include “appraisal of own skills and aptitudes,” “interest in helping people,” “job security prospects,” “prestige of discipline,” “financial prospects,” and “parents/relatives.”
Previous studies have identified personal interest as the most influential factor in career decision-making [11]. Other significant factors include gender, income prospects, lifestyle attributes, and social responsibilities [4].
This study aims to not only analyze the career paths and factors influencing the career choices of medical school graduates currently working in the Daejeon, Sejong, and Chungcheongnam-do (DSC) region but also explore effective career guidance strategies in medical education and propose directions for strengthening professionalism across the medical field. Accordingly, the following research questions were formulated: What career paths are medical school graduates currently working in the DSC region? What factors influence career decisions at each stage of the career paths of medical school graduates in the DSC region?
Methods
1. Data collection
This study analyzed the career paths and factors influencing the career choices of medical school graduates in the DSC region while exploring effective career guidance strategies for medical students. To collect qualitative data, one-on-one in-depth interviews were conducted with 10 graduates using a semi-structured interview question (Table 1).
Content of a Semi-Structured Interview Questions for In-Depth Interview
The sample size was determined based on previous qualitative studies on career-related in-depth interviews, such as the study by Oh and Choi [12], which conducted interviews with nine participants. Accordingly, 10 participants were initially set as the minimum expected number. In this study, thematic saturation was reached at 10 interviews, as no new themes emerged beyond this point, indicating that additional interviews were unnecessary.
The interviews were conducted face-to-face at the participants’ workplaces between February 21 and March 9, 2023, with each session lasting approximately 1 hour. To ensure consistency in questioning, a single researcher conducted all interviews. Recordings were made with participants’ consent and transcribed using NAVER’s ClovaNote program (NAVER, Seongnam, Korea), with the transcripts reviewed for accuracy. For one participant who declined to be recorded, the analysis relied on their preinterview questionnaire responses and the researcher’s notes.
This study was approved by the Institutional Review Board (IRB) of Chungnam National University Hospital (IRB no., 2023-01-040), and informed consent was obtained from all participants after providing sufficient explanation about the purpose and procedures of the study.
2. Participant selection
Physicians with at least 5 years of experience who graduated from or were currently practicing in the DSC region were recruited. The study targeted individuals at a stage suitable for reflecting on their career exploration based on the framework suggesting that career establishment began in the early 30s [13-16].
The DSC region was designated as a unified area to foster core competencies through collaboration among local governments, universities, and regional innovation institutions. This has facilitated active exchange among medical professionals in education and specialized organizations [17]. Furthermore, as medical professionals are increasingly concentrated in the Seoul metropolitan area, examining career trajectories within the DSC region provides valuable insights into regional healthcare workforce distribution and career decision-making.
Factors such as gender, specialty, and institution type and size were considered to ensure diverse perspectives.
Participants were initially selected using purposive sampling to ensure representation across various career paths, including primary care, tertiary care, basic medical sciences, and public service. The recruitment process began by explaining the study’s objectives to an alumni association of a single medical school and requesting recommendations for participants who could represent diverse professional backgrounds.
As the study progressed, snowball sampling was employed to recruit additional participants through professional networks. Among those recommended, public service professionals were the only group that had graduated from different medical schools but were practicing in the DSC region. Additionally, even among graduates of the same medical school, some had completed their internships, residencies, or graduate studies at other universities or affiliated hospitals within the DSC region, reflecting the mobility of medical professionals within the area.
3. Data analysis
This study utilized the constant comparative method to analyze the collected qualitative data [18,19]. This method effectively analyzes diverse data and involves iterative reading and comparing data to identify themes aligned with the research objectives. Emerging themes were reclassified during the analysis, ensuring exclusivity and consistency across categories [20-22] (Fig. 1).
Constant Comparative Method
To enhance the trustworthiness of the study, triangulation was employed. This process involved researchers collaborating to minimize individual biases and ensure the findings were accurately and objectively represented.
From the interview data, two primary meaning units were extracted: (1) career paths and (2) factors influencing career choices.
Similar data were grouped through constant comparisons to derive categories and themes. To ensure the trustworthiness of the findings, cross-validation was conducted by two researchers who independently analyzed and interpreted the data. Additionally, the interpretations were reviewed and validated by medical education experts with over 7 years of professional experience as doctors to enhance credibility and confirmability.
Results
1. Participant information
Participants were initially selected using purposive sampling to ensure representation across various career paths, including primary care, tertiary care, basic medical sciences, and public service. As the study progressed, snowball sampling was employed to recruit additional participants through professional networks.
To ensure diverse perspectives, factors such as gender, specialty, institution type, and size were considered in the selection process. As a result, a total of 10 participants were recruited for this study (Table 2).
Participant Information
Among those recommended, public service professionals were the only group who had graduated from different medical schools but were practicing in the DSC region. Additionally, even among those who graduated from the same medical school, some had completed their internships, residencies, or graduate studies at other universities or affiliated hospitals within the DSC region. This reflects the high mobility of medical professionals within the region, as physicians often move across institutions for different stages of their training and career development.
The participants had a minimum of 6 years and a maximum of 26 years of professional experience. In terms of gender distribution, seven were male and three were female. Regarding job types, participants were categorized as employed physicians, private practitioners, professors, and public officials.
All 10 participants specialized in various medical fields. Their workplace settings included primary care, tertiary care, and central government institutions, demonstrating a diverse range of professional backgrounds and career trajectories.
2. Career paths of medical school graduates
As shown in Fig. 2, participants’ career paths after medical school involved several key decision points, broadly categorized into clinical medicine and basic medical sciences. For clinical medicine graduates, the most critical decision was choosing their specialty after graduating from medical school. Furthermore, deciding which hospital to attend for internship and residency training was crucial, as it was closely linked to their specialty choice.
Career Paths of Medical School Graduates
“That was an important factor and one of the reasons I applied to [** university hospital] was because of the [residency] openings...” (Participant 2)
After selecting a specialty, participants faced further decisions, such as pursuing sub-specialties, graduate studies, or fellowships. Upon completing residency, they chose professional roles, including professors, hospitalemployed physicians, or private practitioners.
Basic medical science graduates generally bypassed internships and residencies, opting for graduate studies. Preventive medicine specialists, positioned between clinical medicine and basic medical sciences, followed a similar trajectory to clinical graduates, involving internships and residency training before choosing their specialty.
Key career decision points for both paths can be summarized as: (1) admission to medical school; (2) postgraduation specialty choices (e.g., internship, residency, graduate studies, and fellowship); and (3) employment choices after training (e.g., academic, clinical, or independent practice).
This study further analyzes the major factors influencing decisions at each career decision point.
3. Factors influencing career choices
Career paths were categorized into three stages: “entering medical school,” “choosing a specialty after graduation (intern, resident, graduate school, fellow),” and “choosing a workplace after training.” Key factors influencing career decisions at each stage were classified into three themes: “personal,” “social,” and “job and work environment” (Table 3). (1) Personal factors: decisions driven by individual characteristics, including interest and passion, aptitude, and personality. (2) Social factors: environmental influences such as family influence (e.g., recommendations, atmosphere), social advice (from friends, seniors, professors), specialty popularity, military alternatives, and broader societal factors. (3) Job and work environment factors: job-specific elements including academic performance, openings (admission possibility), patient interaction, work culture, lifestyle, income, job security, and opportunities for skill development and networking.
Frequency of Career Choice Factors Mentioned by Participants across Career Path Stages
The analysis identified three categories, seven themes, and 18 sub-themes. Table 3 summarizes the frequencies of the mentioned factors across the stages. The key factors for each stage were further grouped and reorganized to obtain deeper insights, as shown in Table 4 and Fig. 3.
Key Factors Influencing Career Choices across Career Path Stages
Analysis of Response Counts for Factors Influencing Career Choices across Career Path Stages
1) Factors influencing admission to medical school
Based on participant interviews, the most frequently mentioned factors influencing admission to medical school were the atmosphere and recommendations from close family and friends such as family and friends. These influences often played a significant role in shaping participants’ decisions.
Additionally, in many cases, other factors such as personal interest, specialty popularity, job security, and academic performance contributed alongside external influences. Conversely, some participants highlighted personal interest as the sole factor driving their decision to pursue medical school, independent of recommendations or influences by others.
a. Family atmosphere and recommendations from close family and friends
Participants often mentioned that family recommendations or the overall family atmosphere significantly influenced their decision to pursue medical school. Opinions from fathers and mothers were particularly impactful in guiding their choices. Additionally, when parents worked in the healthcare sector, even without direct recommendations, participants naturally gravitated toward medical school as a career path.
The influence of close family and friends and their recommendations can be categorized into the following four types:
First, some participants cited family recommendations or environment influencing medical school choices.
“My father … seeing people around him, he thought being a doctor seemed like a decent profession. He suggested I consider it…” (Participant 3)
“Both my grandfather and father specialized in internal medicine and diabetes, so for me, becoming a doctor felt natural from a young age. No one explicitly told me to become a doctor, but …” (Participant 4)
Second, in other cases, participants stated that both the influence of close family and friends and their own interests played a role in their decision.
“When I was in the fourth year of pharmacy school, my friends suggested I try it. So, I took the MEET exam in August. While studying pharmacy, I found experiments fascinating … I wanted to research the human body.” (Participant 9)
Third, some participants noted that, in addition to family influence, factors like the popularity of the medical field or job stability also shaped their decision.
“My mom was a nurse, and my aunt is a pharmacist. … my mom and aunt, who are close, often talked about hospitals. I grew up very familiar with the healthcare field … Medical school is still popular now, but it was also very popular back then.” (Participant 10)
“My brother insisted I should go to medical school. … And I also thought I could have a stable career.” (Participant 2)
Lastly, in some cases, factors such as academic performance, personal aptitude, and family atmosphere influenced the decision.
“Academic performance played a big role. I wondered which schools would be good if I didn’t go to Seoul. After my father passed away, I felt it would be hard to retake the entrance exam to go to Seoul. … In aptitude tests, I always scored as being suited for medicine. … I decided to trust the results.” (Participant 5)
These examples illustrate the diverse and multifaceted factors influencing participants’ decisions to pursue medical school. While family recommendations and atmosphere often played a central role, other elements such as personal interests, job stability, specialty popularity, and academic performance also contributed to varying degrees.
2) Choosing a specialty after graduation (intern, resident, graduate school, fellow)
All participants highlighted personal factors such as interest, aptitude, and personality as significant influences on their post-graduation specialty choices—additionally, other factors combined to shape their decisions.
a. What suits me best
All participants consistently identified personal interest, aptitude, and personality as the most critical factors influencing their decisions regarding internships, residences, graduate studies, and fellowships.
“Ultimately, the most influential factor was my interest.” (Participant 1)
“I enjoy talking to people. While treatments like medication and injections are fine, I wanted something that allowed for meaningful communication.” (Participant 2) “I like working with my hands, building and creating things, so it aligned well.” (Participant 3)
“I wanted to focus on science, constantly questioning why certain things hadn’t been researched.” (Participant 9)
Most participants applied a “rule-out” approach, eliminating specialties that did not suit them.
“I ruled out specialties that didn’t fit me. Most people around me did the same. We call it rule-out during diagnosis, and I applied that to career choices too.” (Participant 1)
“I realized certain specialties didn’t match me, like ***, where work is mostly based on lab results. Neurology, however, required more direct patient interaction, which suited me better.” (Participant 2)
b. Influence of mentors and work culture
Mentors, including seniors and professors, and the work environment were significant factors.
• Considering seniors:
“I liked the seniors working in anesthesiology at the time and often called them for advice.” (Participant 6)
“Having supportive seniors during the stressful internship period mattered.” (Participant 1)
• Encouragement from seniors and professors:
“My third- and fourth-year seniors encouraged me to join their department.” (Participant 3)
“In my first year of residency, professors chose subspecialties for us, not the other way around.” (Participant 4)
• Team dynamics and work culture:
“I couldn’t see myself working with certain teams for 4 years, but I found pediatrics welcoming, with intelligent and supportive colleagues.” (Participant 5)
“I preferred a family-like atmosphere with strong bonds between colleagues.” (Participant 6)
c. Professional growth and lifestyle
Participants often factored in professional growth opportunities, lifestyle preferences, and work-life balance when choosing their specialty.
• Professional growth opportunities:
“Even in preventive medicine, I felt the need to broaden my experience and network, so I chose a hospital offering such opportunities.” (Participant 10)
“A question from a parent during my residency inspired me to research how anesthesia affected brain development. That’s why I pursued graduate school.” (Participant 6)
• Lifestyle preferences:
“I wanted a lifestyle where I could leave work behind at the end of the day, so I chose an outpatient-focused specialty.” (Participant 3)
d. Practical factors in career decisions
A practical factor, such as residency openings, also influenced specialty choices. One participant mentioned that he pursued his internship and residency training at a different hospital after graduating from medical school for this reason. One participant responded that in certain specialties, completing a fellowship is often essential for maintaining a competitive edge in the job market, which influenced his career choice.
• Residency openings
“That was an important factor and one of the reasons I applied to [** university hospital] was because of the [residency] openings…” (Participant 2)
• Job market competitiveness
“If I didn’t do a fellowship before, I would be less competitive in the job market, especially in a field like orthopedic surgery” (Participant 1)
3) Choosing a workplace after training
After completing their residency, graduate studies, or fellowship, participants entered the stage of selecting a workplace. At this stage, they reflected more deeply on what they enjoyed and what suited them. Some were influenced by mentorship or the desire to work with admired colleagues. Others prioritized factors such as work-life balance, compensation, or opportunities for professional growth.
a. Reflection on what I enjoy and what suits me
The most frequently mentioned factors were personal interest, aptitude, and admiration for certain roles.
“A senior asked me to manage a private clinic temporarily, but 99 out of 100 patients had colds. I couldn’t see myself doing that. It felt like a waste of my training. That’s when I decided to stay in academia. I also admired professors— they seemed like experts contributing to knowledge. I’ve always thought being a professor would be great.” (Participant 5)
“I wanted a job that provided an independent workspace. Since I have severe allergies, I looked for indoor options, which influenced my choice.” (Participant 9)
Some participants stated that a key factor influencing their decision was evaluating how well their characteristics aligned with the job requirements.
“Disease policy has clear goals—reducing mortality, preventing disease. That clarity led me to choose my job.” (Participant 10)
After starting their roles, some participants discovered that certain aspects of their jobs differed from what they had expected.
“I thought major surgeries and saving critical patients could only be done at a university hospital. But I didn’t know professors needed to teach and conduct research in addition to treating patients.” (Participant 7)
b. Influence of seniors and colleagues
Influencing factors included recommendations from seniors or the desire to work with colleagues they liked.
“The directors of this hospital asked me to join when they were establishing it, so I decided to join them.” (Participant 3)
“At that time, there was someone named [***] … I honestly thought it would be great to continue working with them.” (Participant 6)
c. Life and professional growth
Personal life and professional growth factors, such as competency enhancement and career advancement, also influence workplace choices. While earlier career decisions emphasized professional growth, this stage saw more responses focused on life-related considerations than professional growth.
• Work-life balance:
“In tertiary hospitals, neurology doesn’t allow for good work-life balance because of emergencies and critical patients. But after earning my board certification, I chose a job with better balance.” (Participant 2)
Some participants noted a disconnect between their expectations and reality.
“I thought professors had more leisure, attending international conferences and building experience. But I realized it wasn’t as relaxed as I had imagined.” (Participant 5)
• Compensation and competency enhancement:
“Specialized hospitals generally pay better than general hospitals. Since I’m married with kids, that mattered. I also wanted to develop more specialized skills in spinal care, which led me to make the move.” (Participant 1)
These findings show that participants’ workplace choices are influenced by personal interests, mentorship, lifestyle considerations, compensation, and professional growth opportunities, with work-life balance being relatively more important at this career stage than earlier.
Discussion
This study explored the career paths and factors influencing the career choices of medical school graduates in the DSC region to propose improvements for career guidance and development for medical students and graduates. Although this study focused on a specific region, its findings align with previous research, suggesting that the results may be applicable to broader medical settings. The findings revealed that personal, social, and job and work environment factors shaped participants’ career decisions. Career choices in medicine are influenced by various factors [22]. Similarly, this study confirmed that personal factors such as interest and aptitude, linked to specialty popularity and lifestyle, played a significant role in career decisions [23]. Additionally, mentors, senior colleagues, and role models were found to have a multifaceted influence on these decisions [23,24]. Furthermore, research opportunities were strongly associated with pursuing academic medicine careers [24].
Unlike many studies focusing on specialty and subspecialty selection factors [1-9,11,25-27], this study takes a long-term view of individual career trajectories. The findings revealed differences in the key factors influencing career choices at each stage of the career pathway. These differences provide insights into the types of career support required at the basic medical education (BME), graduate medical education (GME), and continuing professional development (CPD) stages.
Based on the findings, several critical support measures can be proposed for each stage of the career pathway. The most significant stage is post-graduation specialty selection, which involves many decisions. This stage is particularly influenced by personal characteristics [23,28], highlighting the need for BME to create opportunities for students to self-reflect through diverse activities. During the residency period, the people participants worked with and the workplace culture had a substantial impact [29]. Therefore, fostering a positive hospital culture and improving resident welfare systems are essential [30]. Participants also expressed a strong desire for growth during this stage, emphasizing the importance of enhancing the quality of GME programs.
When selecting a workplace after the training stage, participants focused more on aligning their personal traits with suitable job roles and environments. Practical considerations, such as compensation and work-life balance, were particularly significant during this phase. To support career decisions at the GME and CPD stages, mentoring programs should provide detailed information about job roles, workplace environments, and compensation [31].
Additionally, the findings indicated a tendency for graduates to move between universities and hospitals within the DSC region to pursue career growth and professional development. This suggests the need for a well-structured regional career development network to strengthen the local healthcare system and retain medical professionals within the region.
This study has some limitations. First, it is limited to a specific region, which restricts the generalizability of the findings. Second, the small sample size makes it difficult to claim that the results represent the experiences of all medical school graduates. Third, as participants made their career decisions in a different generational context than current medical students, further research focusing on the latter group is needed. Fourth, this study did not deeply consider the impact of policy influences on medical graduates’ career choices. However, such influences could be a critical factor in shaping career trajectories. Furthermore, an in-depth analysis of the structural correlation between career choice motivations and job satisfaction in future research could provide valuable insights into the long-term implications of career decisions.
Future studies should incorporate these aspects while including more extensive and diverse samples to provide a broader and more comprehensive understanding of medical career development.
In conclusion, this study emphasizes that career decisions of medical graduates are not solely based on individual preferences but are also influenced by social contexts and environmental factors. This highlights the need for a tailored support system across the entire career trajectory, including BME, GME, and CPD. Accordingly, medical education and policy makers should provide students with diverse experiences and mentoring opportunities to facilitate self-exploration while also developing strategies at the healthcare system level to ensure a balanced distribution of medical professionals.
To conclude this discussion, we highlight a participant’s response that encapsulates the essence of career support:
“(What matters in career support) is helping individuals answer the question of how and why they live, with the support of those around them.” (Participant 9)
Notes
Acknowledgements
We would like to acknowledge the contributors who provided valuable support in administrative tasks, assisted during the research process, and participated in proofreading.
Funding
This work was supported by research fund of Chungnam National University.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
SYL and JLK conceptualized the study design and drafted the interview questionnaire. SYL acquired the data and wrote the initial manuscript draft. JLK critically reviewed initial manuscript draft. According to the reviews, SYL revised the draft. All authors read and approved the final submitted manuscript.