Predictors of neurosurgical career choice among residents and residency applicants

OBJECTIVE: Medical students applying for neurosurgery residency positions almost all aspire to become academic neurosurgeons. However, most graduates of neurosurgery residency programs ultimately follow careers in private practice. We hypothesized that there might be factors in a resident's application, interviews, or performance during residency that might predict this change in career orientation. METHODS: We retrospectively reviewed the applications, interview evaluations, and residency performance reviews of graduates from the Neurological Surgery program at the University of California, San Francisco and examined factors that might correlate with their career choices. RESULTS: Between 1968 and 2003, 69 neurosurgical residents graduated from the residency program. Of the 54 respondents (78%), 25 (46%) held academic positions and 29 (54%) were in private practice. None of the application data correlated with career choice, and no significant differences in interview scores were observed between academic and private practitioners. Board scores, publications, presentations, and awards received during residency were not predictive of practice orientation. Favorable evaluations during the junior (P = 0.04) and chief residency (P = 0.03) years and pursuit of a subspecialty fellowship (P = 0.006) were predictive. CONCLUSION: Honest discussion between residents and faculty about the choice between academic and private practice careers may be as informative as the three identified predictors of residents' career orientation. Academic faculty members can encourage communication by discouraging the perception that a resident's education might be compromised if he or she expresses interest in private practice rather than academic neurosurgery. Open communication on this issue might enable faculty mentors to actively advise residents in their career decisions and improve the residents' educational environment.