Objectives: To report on rejected choices of specialty as long-term careers and reasons for rejection.
Design: Postal questionnaire survey.
Setting: United Kingdom.
Participants: All graduates of 1996 and 1999 from UK medical schools during their first year after qualification.
Main outcome measures: Any career choice which had been seriously considered and rejected and the reason for its rejection.
Results: In all, 33.1% (1871) of respondents named a rejected choice and gave reasons for its rejection. Disproportionately high numbers rejected the surgical specialties, paediatrics and obstetrics and gynaecology (O&G), using the specialty distribution of positive choices as the comparator. Relatively few doctors rejected general practice (GP) after giving it serious consideration. Doctors rejecting the hospital medical and surgical specialties or paediatrics were most likely to specify reasons relating to quality of life. Three-quarters of the graduates of 1999 who rejected O&G did so because of poor career prospects.
Conclusions: Quality of life issues, and concerns about working relationships, are sufficiently influential to persuade many doctors to abandon an initial choice of medical career. It is unlikely that much of the decline in entry to GP is attributable to rejection of GP by doctors who initially chose it. The decline must therefore represent an increase in the number of doctors who had never seriously considered it as a long-term career choice.