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A Realist Evaluation of Theory about Triggers for Doctors Choosing a Generalist or Specialist Medical Career

Author

Listed:
  • Belinda O’Sullivan

    (Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia)

  • Matthew McGrail

    (Faculty of Medicine, The University of Queensland Rural Clinical School, 78 on Canning St, Rockhampton 4700, Queensland, Australia)

  • Tiana Gurney

    (Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia)

  • Priya Martin

    (Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia)

Abstract

There is a lack of theory about what drives choice to be a generalist or specialist doctor, an important issue in many countries for increasing primary/preventative care. We did a realist evaluation to develop a theory to inform what works for whom, when and in what contexts, to yield doctors’ choice to be a generalist or specialist. We interviewed 32 Australian doctors (graduates of a large university medical school) who had decided on a generalist (GP/public health) or specialist (all other specialties) career. They reflected on their personal responses to experiences at different times to stimulate their choice. Theory was refined and confirmed by testing it with 17 additional doctors of various specialties/career stages and by referring to wider literature. Our final theory showed the decision involved multi-level contextual factors intersecting with eight triggers to produce either a specialist or generalist choice. Both clinical and place-based exposures, as well as attributes, skills, norms and status of different fields affected choice. This occurred relative to the interests and expectations of different doctors, including their values for professional, socio-economic and lifestyle rewards, often intersecting with issues like gender and life stage. Applying this theory, it is possible to tailor selection and ongoing exposures to yield more generalists.

Suggested Citation

  • Belinda O’Sullivan & Matthew McGrail & Tiana Gurney & Priya Martin, 2020. "A Realist Evaluation of Theory about Triggers for Doctors Choosing a Generalist or Specialist Medical Career," IJERPH, MDPI, vol. 17(22), pages 1-17, November.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:22:p:8566-:d:447251
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    References listed on IDEAS

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    1. Julie Battilana, 2011. "The Enabling Role of Social Position in Diverging from the Institutional Status Quo: Evidence from the UK National Health Service," Organization Science, INFORMS, vol. 22(4), pages 817-834, August.
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    3. Terence Chai Cheng & Anthony Scott & Sung‐Hee Jeon & Guyonne Kalb & John Humphreys & Catherine Joyce, 2012. "What Factors Influence The Earnings Of General Practitioners And Medical Specialists? Evidence From The Medicine In Australia: Balancing Employment And Life Survey," Health Economics, John Wiley & Sons, Ltd., vol. 21(11), pages 1300-1317, November.
    4. Beatriz Cuesta-Briand & Mathew Coleman & Rebekah Ledingham & Sarah Moore & Helen Wright & David Oldham & Denese Playford, 2020. "Understanding the Factors Influencing Junior Doctors’ Career Decision-Making to Address Rural Workforce Issues: Testing a Conceptual Framework," IJERPH, MDPI, vol. 17(2), pages 1-12, January.
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    Cited by:

    1. Matthew McGrail & Belinda O’Sullivan & Tiana Gurney & Diann Eley & Srinivas Kondalsamy-Chennakesavan, 2021. "Exploring Doctors’ Emerging Commitment to Rural and General Practice Roles over Their Early Career," IJERPH, MDPI, vol. 18(22), pages 1-13, November.
    2. Madhan Balasubramanian & Stephanie Short, 2021. "The Future Health Workforce: Integrated Solutions and Models of Care," IJERPH, MDPI, vol. 18(6), pages 1-4, March.

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