How do Internal Medicine Residents from Different Backgrounds Make Subspecialty Career Choices? A Qualitative Analysis

TL;DR

This study explores how internal medicine residents from different backgrounds decide on subspecialties, highlighting factors like mentorship and representation that influence women and underrepresented minorities.

Contribution

This is the first study to explore IM residents' own stated reasons for subspecializing, focusing on disparities among women and underrepresented minorities.

Findings

Contextual factors like mentorship and exposure were most influential in subspecialty choices.

Women and UIM residents emphasized representation and belonging more than their counterparts.

Family planning was a significant factor for women's career decisions.

Abstract

Medical career decisions are complex. Gender and racial disparities remain among internal medicine (IM) subspecialty fellows, particularly in procedural subspecialties. This qualitative study aims to thematically explore factors that influence IM resident subspecialty career choice, with a focus on factors specific to women and UIM trainees to better understand existing disparities. This is the first study to explore IM residents own stated reasons to subspecialize into various fields.

We conducted virtual focus groups with 37 IM residents from multiple institutions, organized by affinity groups based on self-identifying as UIM and non-UIM race or ethnicity. Thematic analysis using inductive coding was used to analyze the data and identify themes applying the Systems Theory Framework (STF) of career development. Key themes were divided into social or contextual factors, individual factors, or uncontrollable factors.

Study participants were 45.9% women (n = 17) and 51.4% self-identified as UIM (n = 19). In this sample of graduating IM residents who have matched into subspeciality fellowships, contextual factors emerged as the most influential to their career choices. The main contributors to selecting a subspecialty were mentorship and role models, positive experiences and exposure to the field, work-life balance, enjoyment of clinical and/or procedural work, and financial compensation. UIM residents identified their communities and their personal identities (i.e., race, ethnicity, culture) as influential to their career choices. Both women and UIM residents more frequently described the importance of representation and belonging in their career decisions compared to their non-UIM and male counterparts. Family planning emerged as an important factor for women.

Our findings lend insights into how academic institutions, medicine subspecialty societies, training programs, and faculty at large can engage trainees in their field. We propose ways to improve the recruitment and retention of women and UIM trainees into the IM subspecialty fields.

The online version contains supplementary material available at 10.1007/s11606-025-09967-9.

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