What predicts doctors' satisfaction with their chosen medical specialty? A Finnish national study.

BACKGROUND: In Finland the number of medical specialists varies between specialties and regions. More regulation of the post-graduate medical training is planned. Therefore, it is important to clarify what predicts doctors' satisfaction with their chosen specialty. METHODS: A random sample contained 50% of all Finnish doctors under 70 years of age. The respose rate was 50.5%. Working-age specialists were asked to value their motives when choosing a specialty. They were also asked if they would choose the same specialty again. The odds ratios for not choosing the same specialty again were tested. RESULTS: Diversity of work was the most important motive (74% of respondents). Seventeen percent of GPs would not choose the same specialty again, compared to 2% of ophthalmologists and 4% of pediatricians. A major role of Diversity of work and Prestigious field correlated with satisfaction whereas Chance with dissatisfaction with the specialty. DISCUSSION: Motives and issues related to the work and training best correlate with satisfaction with the specialty. CONCLUSIONS: When the numbers of Finnish postgraduate medical training posts become regulated, a renewed focus should be given to finding the most suitable speciality for each doctor. Information about employment and career advice should play an important role in this.

Factors important in the choice of a medical career: a Finnish national study.

BACKGROUND: Applying for medical school is the first and also one of the most important career choices a physician makes. It is important to understand the reasons behind this decision if we are to choose the best applicants for medical schools and enable them to pursue satisfying careers. METHODS: Respondents to the Finnish Junior Physician 88, Physician 1998 and Physician 2008 studies were asked: "To what extent did the following factors influence your decision to apply for medical school?" In 1998 and 2008 the respondents were also asked: "If you were starting your studies now, would you start studying medicine?" and had to answer "Yes" or "No". The odds ratios for the answer "No" were tested using logistic regression models. RESULTS: "Interest in people" was the main motive for starting to study medicine. "Good salary" and "Prestigious profession" were more important motives for males and "Vocation" and "Interest in people" for females. There were some significant changes in the motives for entering medicine in the 20-year period between studies. "Vocation" and "Wide range of professional opportunities" as important motives for entering medicine predicted satisfaction with the medical profession. DISCUSSION: Strong inner motivation may indicate the ability to adapt to the demands of work as a physician. CONCLUSIONS: Medical schools should try to select those applicants with the greatest vocational inclination towards a medical career.

Factors associated with general practice specialty training satisfaction - results from the Finnish Physician Study.

In Finland, achieving licensure as a specialist in general practice takes six years, with four years of training in primary care. Usually training arrangements are evaluated by trainees and their trainers. In this study the opinions of licensed GPs with experience of working in practice were specifically addressed. Our aim was to evaluate Finnish general practitioners' satisfaction with their specialty training and with the training programme. Correlations between these evaluations were investigated using logistic regression analyses. Participants comprised 416 GPs and 131 GP trainees, who responded to the Finnish Physician 2008 Study (response rate 53.7%). The respondents were asked how satisfied they were with their own specialty training in general, how satisfied they were with 12 items in their specialty training programme, and how well specialty training matched the requirements of GP work. Two-thirds of GPs and GP trainees were satisfied with their specialty training. Almost three in four felt that GP training succeeded in matching the requirements of work in general practice. Good ratings of diagnostic skill learning during GP training were predictive of overall training satisfaction. Clinical training relevant to GP work is the key element in ensuring satisfaction with general practice specialty training. The views of qualified GPs with experience gained in work provide a valuable addition to the total transformational quality management of GP training.

The non-clinical contents of GP training need more attention. Results from the Finnish Physician Study.

BACKGROUND: The competencies required of a GP are complex and ever-expanding. GP training should adequately cover all the content areas. OBJECTIVES: The aim was to assess GPs' and GP trainees' satisfaction with their specialist training and with the contents of training. Trends in assessments over a ten-year period were investigated. METHODS: Data from Finnish national surveys of physicians conducted in 1998, 2003 and 2008 were analysed with 606, 457 and 324 GPs and GP trainees respectively being sampled in the present study. Respondents were asked how satisfied they were with their own specialist training in general, and how much instruction they had received in 12 specific areas during their specialist training. RESULTS: Satisfaction with GP training slowly increased during the study years. In 2008, 59% of respondents were satisfied with their training, compared to 46% in 1998. The best covered content area was clinical work. Major shortcomings were reported in many of the content areas analysed, e.g. management and leadership. CONCLUSION: Although the trend in satisfaction with GP training in Finland is for the better, there are shortcomings, especially in many of the non-clinical content areas of training. More attention needs to be paid to these areas in the future.

How do doctors choose where they want to work? - motives for choice of current workplace among physicians registered in Finland 1977-2006.

Though there are a number of studies investigating the career choices of physicians, there are only few concerning doctors' choices of workplace. A random sample (N=7758) of physicians licensed in Finland during the years 1977-2006 was surveyed. Respondents were asked: "To what extent did the following motives affect your choice of your current workplace?" Respondents were grouped based on several background variables. The groups were used as independent variables in univariate analysis of covariance (ANCOVA). The factors Good workplace, Career and professional development, Non-work related issues, Personal contacts and Salary were formed and used as dependent variables. There were significant differences between groups of physicians, especially in terms of gender, working sector and specialties. The association of Good workplace, Career and professional development, and Non-work related issues with the choice of a workplace significantly decreased with age. Female physicians were more concerned with Career and professional development and Non-work related issues. Since more females are entering the medical profession and there is an ongoing change of generations, health care organizations and policy makers need to develop a new philosophy in order to attract physicians. This will need to include more human-centric management and leadership, better possibilities for continuous professional development, and more personalized working arrangements depending on physician's personal motives.

Impact of EPR systems on information flow in Finnish health centers.

INTRODUCTION: We studied how well healthcare personnel in healthcare centers (HCs) in the South Ostrobothnia region of Finland are able to obtain patient information thorough electronic patient record (EPR) systems. This study followed the changes in availability of patient information during a 7-year period, from 2003 to the end of 2010. The patient group studied focused on those involved in anticoagulant (AC) treatment. SUBJECTS AND METHODS: A structured questionnaire was sent in 2003 to the staff of 15 HCs. The questionnaire dealt with access and availability of patient information from the EPR. Respondents were asked to rate how often they obtain information concerning AC treatment from various sources. RESULTS: In total, 1,114 questionnaires were sent, and 860 answers were received; the response rate was 77%. A repeat study was conducted in 2010, and 932 responses were obtained (response rate, 56%). Paper-based AC treatment cards carried by the patients were an important information source for 75.0% of the respondents in 2003 and 55.4% in 2010. For all new AC treatments, the EPR was a primary information source for 33.3% of respondents in 2003 and 60.2% in 2010. CONCLUSIONS: This study indicated that during the study period there was an improvement in access to EPR but that this did not always improve the overall availability of data. Results show that problems in information flow from secondary care to the HCs persist. Almost half of the patients dealt with in the HCs were affected by at least some problems. In the 7 years covered by this study, EPR systems have become more important as information sources for clinical data, but there is still room for improvement.

Where have all the GPs gone--where will they go? Study of Finnish GPs.

BACKGROUND: In this paper a specialist in general practice is referred to as a general practitioner (GP). In Finland only half of all GPs work as a health centre physician. The present aim was to establish what the working places of specializing and specialized physicians in general practice are, and where they assume they will work in the future. METHODS: The study population comprised 5,357 physicians licensed in Finland during the years 1977-1996. Altogether 2,956 questionnaires were returned, a response rate of 55.2%. Those either specializing (GP trainees, n=133) or already having specialized (GPs, n=426) in general practice were included in the study. Respondents were asked what kind of physician's work they would most preferably do. They were further asked what work they assumed they would be doing in the year 2020. RESULTS: Altogether 72% were working in public primary health centres and 14% in the private sector. Of GPs 53% and of GP trainees 70% would most preferably work in health centres. Of GPs 14% would most preferably work as private practitioners and 9% as occupational health physicians. Sixteen per cent assumed they would be working as private practitioners and 35% assumed they would be retired in the year 2020. Of GP trainees 57% assumed they would be working as health centre physicians in 2020. CONCLUSIONS: According to the present findings many experienced GPs will leave their work as a health centre physician. Moreover, several GP trainees do not consider health centre physician's work as a long-term career option. These trends may in the future reflect a recruiting problem in many primary health centres.

Success in licensing examinations of doctors from outside the European Economic Area: experiences from Finland 1994-2009.

In the licensing process in Finland, of the doctors who have taken their medical degree outside the EU/EEA, a certificate of a language test in Finnish or Swedish is demanded. The Department of General Practice at the University of Tampere takes care of the licensing examinations, including two written medical knowledge tests and clinical skills assessment. The doctors have to prove that they can manage as primary care physicians. In this study, the aim was to investigate the performance of doctors in the licensing examinations. There were 746 doctors in all who had participated in the examinations during 1994-2009. Their success in the exams and numbers of attempts were studied in connection with demographic data. Over half of the participants had passed all three tests and about one-fifth of them had passed them on the first attempt. Gender was the only factor that was associated with good outcome, women being significantly better than men. The Finnish licensing system of non-EEA doctors is equal for all participants. Experienced general practitioners act as evaluators. The purpose is to make responsible assessments of the competency of the doctors, also taking into account the possibility that some doctors may continue to other EEA countries and start practice on the basis of the Finnish licensure.

Choosing a medical specialty--study of Finnish doctors graduating in 1977-2006.

BACKGROUND: Choosing a medical specialty is an important element predefining a physician's career and life. Although there has been some research in this area of interest, there has not been much research where the profession has been researched as a whole, or where trend data over different generations has been presented. AIM: The aim of our study was to ascertain the motives affecting physicians' choice of a medical specialty. METHODS: The study cohort comprised random sample of 7758 doctors who were registered in Finland during the years 1977-2006. Altogether 4167 questionnaires were returned, giving a response rate of 54%. An electronic questionnaire was used in data collection, supported by a traditional postal questionnaire. RESULTS: Of the respondents, 76% thought the diversity of the field had affected their choices of specialty considerably or very much. For physicians under 35 years old, especially the good example set by colleagues (48%), and opportunities for career development (39%) were more important motives compared to those of older physicians. CONCLUSIONS: According to this study, diversity of the work is the main motivating factor affecting physicians' choices of specialty. Especially, younger physicians follow the example set by more experienced colleagues.

[Are there enough medical scientists in Finland?]. / Riittääkö suomessa lääkäritutkijoita?

Discussion within the scientific society and hospital communities has raised concerns of the current status and future of clinical research in Finland. One of the crucial future challenges is whether there are enough medical scientists that are able to perform clinical research and comprehend and manage medicine as a whole. In the article, the authors present suggestions for solving the problematic issues.

Management of electronic patient record systems in primary healthcare in a Finnish county.

We investigated factors that could govern the use and user competence of electronic patient record (EPR) systems used in Finnish primary healthcare in the county of South Ostrobothnia. A structured questionnaire was sent to 400 health center (HC) staff (general practitioner, nurse, and clerical) from eight HCs. The questions dealt with Information Technology (IT) management, use, and potential problems with EPR and user EPR training within the HC. The response rate to the questionnaire was 79%. This study shows that there are large differences in working practices and in the way EPR systems are managed and utilized in the primary care organizations studied. A relatively high level of self-reported lack of competence in EPR use (21%) was indicated by the HC staff, clearly indicating that there is a need to improve user training. Results also indicate clear correlations between the incidence of user problems and whether there were routine procedures to disseminate best EPR user practices at the HC. If the HC had a clear IT development strategy, personnel were more likely to utilize the EPR system to develop the workflow and work practices of the HC. This study showed the importance of the EPR as a tool for a wide variety of tasks not restricted to patient data access. To improve and broaden the use of the EPR systems, more emphasis should be placed on IT management, support, training, and "best practices" dissemination.

Who receives anticoagulant treatment with warfarin and why? A population-based study in Finland.

OBJECTIVE: To ascertain the age and gender distribution of patients receiving anticoagulant (AC) treatment with warfarin, and to establish the prevalence of AC treatment and its indications among the Finnish population. DESIGN: A cross-sectional study in which the patients were identified from the patient records of health centres. SETTING: Primary health care in the Hospital District of South Ostrobothnia in Finland. PATIENTS: Those inhabitants of 15 municipalities in the study area who received AC treatment with warfarin on 1 April 2004. The total number of inhabitants was 132 621 at the end of 2003. MAIN OUTCOME MEASURES: Patient age and gender distributions, the prevalence of AC treatment in the study area, and indications for AC treatment. RESULTS: Altogether 2389 patients were identified, 51.4% of them men. The mean age of the patients was 72.4 years. The prevalence of AC treatment was 1.8%; when age-adjusted to match the Finnish population it was 1.64%. The proportion of men receiving AC treatment was higher than that of women in all age groups. Atrial fibrillation (AF) was the most common main (60.2%) and second (7.2%) indication for AC treatment. CONCLUSION: Compared with Finnish figures 12 years earlier the prevalence of AC treatment has more than doubled, and the proportion of AF among indications has increased from 47% to 67%. New current care guidelines on AF and the increasing proportion of the elderly among the population are probable explanations.

Use of quality improvement methods in Finnish health centres in 1998 and 2003.

OBJECTIVE: To evaluate how widely quality improvement methods are used in Finnish primary health centres and how the use has changed over five years. DESIGN: Two national cross-sectional postal enquiries. SETTING AND SUBJECTS: The questionnaire in 1998 was sent to every other physician graduated during the years 1977-1986, and the questionnaire in 2003 to every other physician graduated during the years 1982-1991. The response rates were 73.9% and 62.2%. The answers of primary healthcare physicians (n = 503 vs. 344) were analysed. MAIN OUTCOME MEASURES: The availability of 13 quality improvement methods was solicited. The change over five years was analysed. RESULTS: Opportunity to obtain continuing medical education (CME), in-service training, meetings, opportunity to consult a colleague in own speciality, and agreed guidelines on how a certain problem should be solved were highly reported both in 1998 and 2003. The biggest improvement (16.8%) concerned clinical guidelines. There was also progress with regard to quality improvement manuals at the place of work, opportunity to consult a colleague in another speciality, and computer-assisted monitoring of own work. CONCLUSION: Many quality improvement methods were highly reported in both 1998 and 2003 in Finnish health centres. The biggest positive change concerns clinical guidelines.

Sexual intercourse and current contraceptive use among university students in Finland.

OBJECTIVE: To ascertain the current frequency of sexual intercourse, the current use of contraceptives, the ever use of emergency contraception, and the ever experience of condom failure among Finnish university students. STUDY DESIGN: The study population consisted of Finnish undergraduate university students (19-34 years of age) in 2004. The randomly selected sample comprised 5030 subjects. The data were collected by postal questionnaire, the response rate being 62.7%. Data were presented with frequency distributions and cross-tabulations. Chi-square test was used. Frequencies for women and men were presented and tested separately. RESULTS: A total of 80% of students were currently practicing sexual intercourse. Approximately half of the female students currently used hormonal contraception and one-third used a condom. Almost half of the men currently used a condom. The simultaneous use of condom and hormonal contraception was rare. Condom failure was common. The ever use of emergency contraception appeared to be associated with condom failure. CONCLUSION: Of Finnish university students 80% were sexually active and hormonal contraceptives were the most popular method of contraception among female students. The use of the condom should be practiced more often for prevention of sexually transmitted diseases.

The role of job satisfaction, job dissatisfaction and demographic factors on physicians' intentions to switch work sector from public to private.

This study is based on a unique data set for the years 1988-2003 and uses structural equation models to examine the impact of job satisfaction and job dissatisfaction on physicians' intention to switch from public- to private-sector work. In Finland, physicians who work primarily in a public-hospital or health-centre setting can also run a private practice. Therefore, we also analysed the impact of having a private practice on a physician's intention to change sector. We found that private practice had a positive, statistically significant effect on the intention to switch sector in 1998 and 2003. Results also suggest that job satisfaction decreases a physician's intention to switch sector, although for 1998 it had no effect. Surprisingly, job dissatisfaction significantly increased the physicians' intentions to leave the public sector only in the 1988 data.

Factors associated with physicians' choice of working sector: a national longitudinal survey in Finland.

OBJECTIVE: To analyse factors affecting physicians' choice to work in either the public or the private sector. METHOD: We undertook a longitudinal data analysis in the years 1988, 1993, 1998 and 2003 (n = 12 909) using a multilevel modelling technique. Factors related to economic factors, physician identity, appreciation as well as demographic factors were hypothesised to influence sector choice. RESULTS: Physicians seem to make their career choices prior to graduation, at least to some extent. Wage levels, the physician's personal characteristics and whether or not the physician knew his or her place of work before graduation were the key factors affecting the decision-making process in the years 1988, 1993, 1998 and 2003. Physicians for whom wages were important were less likely to choose the public sector. Also, physicians who regarded themselves as entrepreneurial preferred to work in the private sector. If a physician had worked in the public sector during his or her medical training before graduation, the probability of applying for a vacancy in the public sector was higher. CONCLUSION: It is not only economic factors, such as salary, that are involved in the physician's decision to choose the working sector.

Childbearing and the desire to have children among university students in Finland.

BACKGROUND: The fertility rate in Europe is low and there is concern over the low birth rate in relation to the aging population. The age of childbearing women has increased and infertility is a growing problem. Highly educated women in Finland suffer from childlessness more often than less educated women. The aim of this study was to establish Finnish university students' actual and desired number of children, and compare the economic and educational situations of students with and without children. METHODS: The study population consisted of Finnish undergraduate students under 35 years of age. The randomly selected sample was 5,030 subjects. The data were collected by postal questionnaire, the response rate being 62.7%. Frequency distributions, cross-tabulations, and descriptive statistics were used. Categorical variables were tested by the Cochran-Mantel-Haenzel test. RESULTS: 7.5% of students had children. Almost 90% desired to have children. Parenthood did not correlate negatively with satisfaction with financial situation or completed studies. CONCLUSION: University students are seldom parents, though they are at the ideal age for childbearing and the majority desire to have children. The risk of unintended childlessness exists, when pregnancies are postponed because of unfinished studies.

Consultations concerning contraception and induced abortions among university students--trends in Finland 1986-2003.

The Finnish Student Health Service (FSHS) provides primary health care services to university students in Finland. The material for this study was drawn from the statistics of the FSHS. From 1986 to 2003, the number of students increased by 50%, while physician consultations did not, indeed to the contrary. The numbers of family planning consultations fell from 358 to 217 per 1000 female students. The induced abortion rates among university students are very low compared with the population in general and decreased from 4 to 3 per 1000 female students. Students are responsible, and because they want to postpone pregnancy after studies, they use contraceptives effectively. The FSHS has succeeded in guaranteeing contraception services and in preventing unwanted pregnancies and minimizing the need for induced abortions among university students while at the same time decreasing physician consultations. This was possible by changing the distribution of tasks among physicians and nurses, and by adding telephone contacts instead of face-to-face consultations with physicians.