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Article

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

1
Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia
2
Faculty of Medicine, The University of Queensland Rural Clinical School, 78 on Canning St, Rockhampton 4700, Queensland, Australia
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(22), 8566; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228566
Received: 14 October 2020 / Revised: 9 November 2020 / Accepted: 17 November 2020 / Published: 18 November 2020
(This article belongs to the Special Issue The Future Health Workforce: Integrated Solutions and Models of Care)
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. View Full-Text
Keywords: career choice; generalist; general practice; specialist; medical training; doctors; realist evaluation; theory; experience; norms; attributes career choice; generalist; general practice; specialist; medical training; doctors; realist evaluation; theory; experience; norms; attributes
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MDPI and ACS Style

O’Sullivan, B.; McGrail, M.; Gurney, T.; Martin, P. A Realist Evaluation of Theory about Triggers for Doctors Choosing a Generalist or Specialist Medical Career. Int. J. Environ. Res. Public Health 2020, 17, 8566. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228566

AMA Style

O’Sullivan B, McGrail M, Gurney T, Martin P. A Realist Evaluation of Theory about Triggers for Doctors Choosing a Generalist or Specialist Medical Career. International Journal of Environmental Research and Public Health. 2020; 17(22):8566. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228566

Chicago/Turabian Style

O’Sullivan, Belinda, Matthew McGrail, Tiana Gurney, and Priya Martin. 2020. "A Realist Evaluation of Theory about Triggers for Doctors Choosing a Generalist or Specialist Medical Career" International Journal of Environmental Research and Public Health 17, no. 22: 8566. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228566

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