Multicentric Cross-sectional Study on Determinants in Choosing Subspecialties in Internal Medicine and Job Satisfaction Among Internal Medicine Trainees and Specialists in the USA

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Background/ Purpose: To analyze the sex distribution of physicians in a specific subspecialty, identify factors influencing subspecialty choice in internal medicine, assess job satisfaction, and evaluate burnout levels among Internal Medicine (IM) trainees and specialists. Methods: A questionnaire-based study was conducted using the Abridged Job Descriptive Index (AJDI) for job satisfaction and the Maslach Burnout Inventory (MBI) for burnout. Participants included IM residents, fellows, attendings, and hospitalists considering fellowship. Descriptive and statistical analyses, including Fisher's exact test, were performed using R to assess trends across subspecialties grouped by fellowship competitiveness. Results: A total of 162 IM physicians participated, with a male predominance in highly competitive subspecialties and female predominance in others. Clinical rotations were the most influential factor in subspecialty choice (64.2%, p=0.012), with most first exposures occurring during residency. Over half reported job satisfaction; depersonalization burnout was significantly higher in the least competitive fellowship group (p=0.023). Conclusion: This study highlights key gender disparities, the strong influence of clinical rotations, and moderate levels of job satisfaction across IM subspecialties, with higher depersonalization in less competitive fields. Declining interest in certain subspecialties reflects concerns about work-life balance, compensation, and limited exposure. Residency programs and policymakers should enhance early exposure, mentorship, and implement targeted incentives to improve recruitment into underserved but essential specialties.

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