This study aimed to investigate and compare male and female students’ specialty preferences and the motives behind them. Our results showed almost no gender differences in the specialties the students opted for. Moreover, men and women had an almost identical ranking order of the motivational factors. Male and female students did differ in the motivational factors that were associated with their specialty preference. However, just two statistically significant gender differences were revealed when using gender as an interaction term. A majority of the women, compared with a good third of the men, intended to work part-time. It was only for women that the ideal number of working hours was linked to the importance they attached to having time for family.
Gender and career preferences
In contrast to earlier studies on medical students, we did not find any significant difference between men and women in their preference for surgery [11, 12, 21]. Our results were supported by a study conducted in all Swedish medical schools where no differences in specialty preference between male and female last-term medical students were revealed . Also, earlier research has shown a trend where the proportions of female medical students who prefer male-dominated specialties are increasing [19, 21]. Still, this equal distribution between men and women clashes with the horizontal gender segregation in medical specialties seen in Sweden and other Western societies [7, 9]. This could either mean that women will continue to increase in male-dominated specialties or that the problem lies after graduation. In a Norwegian study, female and male residents were equally distributed when starting their first specialty training, but fewer women than men finished their specialty training in surgery . Hence, there seem to be barriers such as masculine homosociality, with men preferring men (and excluding women), lack of social support and a scarcity of role models that might only become evident during residency.
That more women than men opted for gynecology and pediatrics could be explained by female physicians being numerous in these specialties over the past decades and hence there are more same sex role models. Also, the students were on gynecological and pediatric training at the time of the questionnaire.
Both male and female students seemed to value patient contact and combining work with family more than career prospects and good salary. This could be explained in part by the fact that a majority of the students lived with a partner and by the age of twenty-seven, family-life might seem close in time. Our results are in concert with another Swedish study, where male and female physicians mainly showed similarities in their specialty motives; interesting content, patient contact and a good working environment were important for both women and men . Yet, our results contrast with previous studies from other countries where mainly women considered work and time-related aspects and patient orientation whereas men considered technical challenge, salary, career prospects and prestige when choosing specialty [11, 15, 16, 18]. Both Norwegian and Swedish students [19, 30] compared with students from, for example, the Netherlands and the U.S. distribute themselves more equally in their specialty preferences and also in how they rate the motives for them [10, 12]. Perhaps this could be explained by different national contexts. The fact that both Sweden and Norway have more far-reaching gender equality legislation compared with countries like the U.S. and the Netherlands , is probably reflected in the values among the medical students. Thus, strong norms of gender equality as a frame of reference might affect the students’ career preferences and their motives for them.
In a study on Swedish residents, men and women in male-dominated specialties (such as surgery) attached similar importance to combining work with family, whereas those in specialties with more women differed in their priorities . The same pattern can be seen in our results as well: men and women who opted for surgical specialties had the same low rating in combining work with family, whereas among those who preferred family medicine it was only women – not men – who considered time for family to be important. Those who opted for family medicine also chose part-time to a higher degree. It seems that women consider family medicine a family friendly specialty. This was consistent with women’s part-time preference being linked to having time for family. Thus, for women family medicine and part-time practice seem to be a strategy to combine work with family duties. For men, the choice of part-time and family medicine is about something else, which remains unmeasured.
Being uncertain and preferring non-surgical specialties were associated with relatively few motivational factors. This could be because these two groups were the most diverse. In the uncertain group there seemed to be a group of female students who were not motivated by patient contact and a group of male and female students who wanted combine work with family. Perhaps this means that if you want to be able to combine work with family in a satisfying way, career choices are much harder to make. Also, it is interesting that female students who went against a traditional gender pattern – being female and less concerned with patient contact – seemed to find it harder to choose a specialty.
A considerable number of students added a good working environment and nice colleagues when asked if something other than the stated motivational factors would affect their specialty preference. This finding is supported by a Swedish study where male and female students described how their reception among colleagues was important when making their career choices . Also, an American study found that the reason for more men choosing surgery could not be explained by the women being deterred from surgery during their clinical rotations but rather that they received more support elsewhere .
To sum up, our results suggest that gender segregation is not just a matter of individual choices and gender-dichotomized preference; instead we found that contexts structure choices. First, in contrast to several other Western societies, Swedish men and women have very similar specialty preferences at the time of their graduation. Second, in the male- dominated surgical specialties both male and female students prioritize family low, whereas for women work-family balance is a major motivational factor to choose family medicine. Third, the importance of social support at the workplace was reflected in the students’ addition of a good working climate as an important factor for specialty preference.
Almost half of the medical students who were standing on the doorstep of working-life preferred a part-time practice. In Sweden, 29% of all female physicians work part-time, which can be compared with a majority of the female students in our study who planned for part-time practice. In a similar vein, 17% of the male physicians work part-time, compared with a good third of the male students who intended to do so . If these students’ preferences stay on and they get their way, the proportion of part-time practicing physicians could be almost doubled within a few decades. In Sweden, parents with small children and a full-time job have a legal right to work part-time (75%). Perhaps, medical students believe that this, together with an expected future shortage of doctors mean that they will be able to negotiate their working hours. In a Nordic report on the future supply of physicians, 20% of all Swedish physicians were expected to practice part- time in 2020 . The report made an underestimation, as 23% of all Swedish physicians practiced part-time already in 2009 . This raises a concern. If a new generation of doctors successfully negotiates part-time practice the shortage of doctors will be even larger than expected. There is however studies indicating that these students will not get what they wish for. Potential medical students in the U.S. also expected medicine to offer the possibility of part-time . This is surprising, as historically the medical profession has been known for its long hours. In most specialties part-time is not a possibility. Structural and cultural barriers are important obstacles for part-time work. Despite a new generation of physicians who value work-life balance  the American trend over the last few decades moves towards working long weeks, mainly because of structural constraints . American physicians who work part-time report less pay for the same work-related expectations and long-term sacrifices such as not being promoted and also criticism from colleagues . Negative attitudes in the workplace toward part-time physicians have been described in Scandinavian studies as well [32, 36]. As the students in this study seem to value the support from colleagues, this suspiciousness toward part-timers will be a rude awakening for the Swedish students when they enter the medical profession.
When the students were asked directly how important it was to be able to combine work with family, both men and women rated it higher than career possibilities. However, when using regression analysis to study the association between combining work with family and ideal work-time it was clear that it was mainly the female students who planned for part-time in order to have time for family responsibilities. This also means that the female students realize that more working hours mean less time for the family. Earlier research showed that female medical students and physicians were more ready than their male peers to compromise career aspirations for family life [17, 22, 32, 33]. Thus, even if Sweden has relatively strong parental leave and childcare provisions, there are still differences in how male and female future physicians plan their careers. In concert with our results, it has been shown before how Swedish medical students receive gendered advice; men were encouraged to stick to what they aspired for and to let family interests come second whereas women were advised to choose a family-friendly specialty . In sum, even if male and female students have similar specialty preferences, it was mainly women and especially those opting for family medicine that planned for work-family balance. However, this did not seem to affect their specialty preference, as there were no gender differences in opting for family medicine and surgical specialties.