Medicine Versus Surgical Specialty Preferences among House Officers in Pakistan: A Multi-Center Cross-Sectional Study and a Literature Review
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Background: Choosing a medical specialty is one of the most important decisions for young doctors. In addition to affecting their personal and professional lives, this choice has an impact on the healthcare system as a whole, influencing service delivery and personnel distribution. This study aims to understand the current specialty preferences of house officers in major Pakistani hospitals and to explore the key factors influencing their decisions. Methods: This is an observational multi-center cross-sectional study and literature review conducted in four major hospitals—Pakistan Institute of Medical Sciences (PIMS), Shifa International, Holy Family, and FAUJI Foundation—between June and July 2025. Data collection employed a self-administered questionnaire via Google Forms. Descriptive analysis and a binary logistic regression model were used to summarize the findings. Results: Among the 180 house officers surveyed in Pakistan, internal medicine was the most desired specialty, chosen by 43.9% of participants. This was followed by general surgery (32.2%) and pediatrics (7.2%). The most common reported factor contributing to the specialty choice was passion, 117 (65.00%). Regarding preference rates for medicine versus surgery, gender, the presence or absence of a role model, and consistency in decision-making were statistically significant predictors. Conclusion: The most sought-after specialty among Pakistani house officers was internal medicine. A strong focus on specialization was driven by passion, gender, and role models.
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[1] Coakley, N., O’Leary, P., & Bennett, D. (2023). Endured and prevailed: a phenomenological study of doctors’ first year of clinical practice. BMC Medical Education, 23(1). https://doi.org/10.1186/s12909-023-04059-w
[2] Yousuf, S., & Siddiqui, N. (2008). Learning procedures during house job. JPMA. The Journal of the Pakistan Medical Association.., 58(12), 698–699
[3] Zhao, Y., Mbuthia, D., Blacklock, C., Gathara, D., Nicodemo, C., Molyneux, S., & English, M. (2023). How do foundation year and internship experience shape doctors' career intentions and decisions? A meta-ethnography. Medical teacher, 45(1), 97–110. https://doi.org/10.1080/0142159X.2022.2106839
[4] Aboshady, O. A., Zenhom, M. S., & Nasr, A. A. (2015). What should medical students do to choose their specialty?. The Pan African medical journal, 22, 282. https://doi.org/10.11604/pamj.2015.22.282.7955
[5] Arif, M. M., Nisar, W., Agha, K., Qureshi, M. G., Mansoor, A., Malik, A. U., Khokhar, M. S., Awan, F., Khwaja, S. I., & Parveen, A. (2023). Exploring Specialty Selection and Influencing Factors among Medical Students and Postgraduates: An Observational Study. Pakistan Journal of Health Sciences, 263–269. https://doi.org/10.54393/pjhs.v4i06.803
[6] Okonkwo, T. C., Olatunji, G. D., Adeleye, V. M., & Akinwale, M. O. (2025). Specialty choice among final-year medical students and house officers in Nigeria: implications for anaesthesia practice – a cross-sectional study. BMJ Open, 15(1), e084517. https://doi.org/10.1136/bmjopen-2024-084517
[7] Yang, Y., Li, J., Wu, X., Wang, J., Li, W., Zhu, Y., Chen, C., & Lin, H. (2019). Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis. BMJ open, 9(3), e022097. https://doi.org/10.1136/bmjopen-2018-022097
[8] Zia, S., Abbas, M., Sulaiman, M., & Sheikh, S. M. (2017). Career Choices of Medical doctors at Graduate level - A Multicenter Study. Pakistan journal of medical sciences, 33(5), 1086–1090. https://doi.org/10.12669/pjms.335.12945
[9] Shakir, M., Irshad, H.A., Ali, E.A. et al. Impact of medical school experiences on the career choice of neurosurgery: a cross- sectional study from Pakistan. BMC Med Educ 24, 465 (2024). https://doi.org/10.1186/s12909-024-05452-9
[10] Idrees, A., Rehman, A. U., Mehmood, M. A., Pahwa, B., Mohsin, A., Shaikh, T., Jesrani, E. K., & Chaurasia, B. (2024). Perception of Neurosurgery as a Career Choice Among Early Career Doctors in Pakistan: A Nationwide Cross-Sectional Survey. World neurosurgery, 183, e598–e602. https://doi.org/10.1016/j.wneu.2023.12.151
[11] Balouch, M. S., Balouch, M. M., Balouch, M. S., Qayyum, W., & Zeb, Z. (2022). Career Aspirations of Junior Doctors in Pakistan: Exploring Reasons Behind the Brain Drain. Journal of Ayub Medical College, Abbottabad:, JAMC.., 34(3), 501–506. https://doi.org/10.55519/JAMC-03-10549
[12] Saeed, S., et al. (2023). Factors associated with medical students' career choices at a private university: a cross-sectional study. Journal of the Pakistan Medical Association, 73(12), 2431–2433. https://pubmed.ncbi.nlm.nih.gov/38083925/
[13] Hamid, S., Ali Inam, S. H., Jamil, H., & Zeb, R. (2019). Speciality preference with respect to gender among medical students of Pakistan. JPMA. The Journal of the Pakistan Medical Association.., 69(8), 1190–1193.
[14] Levaillant, M., Levaillant, L., Lerolle, N., Vallet, B., & Hamel-Broza, J. F. (2020). Factors influencing medical students' choice of specialization: A gender based systematic review. EClinicalMedicine, 28, 100589. https://doi.org/10.1016/j.eclinm.2020.100589
[15] Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. www.OpenEpi.com, updated 2013/04/06, accessed 2025/08/08.
[16] Aslam, M., Ali, A., Taj, T., Badar, N., Mirza, W., Ammar, A., Muzaffar, S., & Kauten, J. (2011). Specialty choices of medical students and house officers in Karachi, Pakistan. Eastern Mediterranean Health Journal, 17(01), 74–79. https://doi.org/10.26719/2011.17.1.74
[17] Okonkwo TC, Olatunji GD, Adeleye VM, et al. Specialty choice among final- year medical students and house officers in Nigeria: implications for anaesthesia practice – a cross- sectional study. BMJ Open 2025;15:e084517. doi:10.1136/ bmjopen-2024-084517
[18] IBM Corp. (2019). IBM SPSS Statistics for Windows (Version 26.0) [Computer software]. IBM Corp.
[19] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
[20] Anand, R., & Sankaran, P. S. (2019). Factors influencing the career preferences of medical students and interns: a cross-sectional, questionnaire-based survey from India. Journal of Educational Evaluation for Health Professions, 16, 12. https://doi.org/10.3352/jeehp.2019.16.12
[21] Ali, A., Rasheed, A., Zaidi, S. M. H., Alsaani, S. M. a. J., Naim, H., Hamid, H., & Farrukh, S. (2019). Recent Trend in Specialty Choices of Medical Students and House Officers from Public Sector Medical Universities, Karachi. PubMed, 69(4), 489–494. https://pubmed.ncbi.nlm.nih.gov/31000850
[22] Sawaf, B., Abbas, F., Idris, A., Saadi, T. A., & Ibrahim, N. (2018). Specialty preference and intentions to study abroad of Syrian medical students during the crisis. BMC Medical Education, 18(1). https://doi.org/10.1186/s12909-018-1146-x
[23] Levaillant, M., Levaillant, L., Lerolle, N., Vallet, B., & Hamel-Broza, J. (2020). Factors influencing medical students’ choice of specialization: A gender based systematic review. EClinicalMedicine, 28, 100589. https://doi.org/10.1016/j.eclinm.2020.100589
[24] Fehlmann, A., Abbiati, M., Dällenbach, P., & Savoldelli, L. G. (2019). Motives influencing students’ preferences for obstetrics and gynaecology speciality: A cross-sectional multi-site Swiss study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 237, 157–163. https://doi.org/10.1016/j.ejogrb.2019.04.036
[25] Hamid, S., Inam, S. H. A., Jamil, H., & Zeb, R. (2019). Speciality preference with respect to gender among medical students of Pakistan. PubMed, 69(8), 1190–1193. https://pubmed.ncbi.nlm.nih.gov/31431778
[26] Kawamoto, R., Ninomiya, D., Kasai, Y., Kusunoki, T., Ohtsuka, N., Kumagi, T., & Abe, M. (2016). Gender difference in preference of specialty as a career choice among Japanese medical students. BMC medical education, 16(1), 288. https://doi.org/10.1186/s12909-016-0811-1
[27] Asaad, M., Zayegh, O., Badawi, J., Hmidi, Z. S., Alhamid, A., Tarzi, M., & Agha, S. (2020). Gender differences in specialty preference among medical Students at Aleppo University: a cross-sectional study. BMC Medical Education, 20(1). https://doi.org/10.1186/s12909-020-02081-w
[28] Harris, M. G., Gavel, P. H., & Young, J. R. (2005). Factors influencing the choice of specialty of Australian medical graduates. The Medical journal of Australia, 183(6), 295–300. https://doi.org/10.5694/j.1326-5377.2005.tb07058.x
[29] Ferreira, T., Collins, A. M., Feng, O., Samworth, R. J., Horvath, R., & AIMS Collaborative (2023). Career intentions of medical students in the UK: a national, cross-sectional study (AIMS study). BMJ open, 13(9), e075598. https://doi.org/10.1136/bmjopen-2023-075598
[30] Alhaddad, M. S. (2018). Undergraduate pharmacy students’ motivations, satisfaction levels, and future career plans. Journal of Taibah University Medical Sciences, 13(3), 247–253. https://doi.org/10.1016/j.jtumed.2018.03.004
[31] Teng, Z. S., Ser, G. T. Z., Hong, W. H., Teo, C. H., Abdul Aziz, Y. F., Vadivelu, J., & Malaysia MedEd Collaborative (2024). Malaysian Medical Students' Career Intention (MMSCI): a cross-sectional study. Human resources for health, 22(1), 59. https://doi.org/10.1186/s12960-024-00939-4
[32] Nadarajah, A., Shankar, P. R., Jayaraman, S., & Sreeramareddy, C. T. (2022). House officers' specialist career choices and motivators for their choice- a sequential mixed-methods study from Malaysia. BMC medical education, 22(1), 796. https://doi.org/10.1186/s12909-022-03845-2
[33] Goldman, A. L., & Barnett, M. L. (2023). Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021. JAMA internal medicine, 183(2), 106–114. https://doi.org/10.1001/jamainternmed.2022.5792
Copyright (c) 2026 Maha Abu Zarifa, Asmaa Zakria Alnajjar, Nasir Ashraf, Mesan Hijazy, Mohammed B. Abu Zarifa, Hazem Ayesh
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