IS PERSONALITY RELATED TO DOCTORS' SPECIALTY CHOICE

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Is personality related to doctors' speciality choice and job satisfaction : a study of a
Cambodian classic
Clack, Gillian Beverley
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IS PERSONALITY RELATED TO DOCTORS' SPECIALTY CHOICE
AND JOB SATISFACTION?"
GILLL4N BEVERLEY CLACK
KING'S COLLEGE LONDON
THESIS SUBMITTED FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
OF THE UNIVERSITY OF LONDON
2002
1L0
\UPP1.
2
ACKNOWLEDGEMENTS
I would like to thank most sincerely all those who have contributed in so many ways towards
the completion of this research and thesis.
In particular, my thanks go to the following:-
Dr John Head, my Ph.D. supervisor, first of all, for his wise counsel and unfailing support at
all times which enabled me to retain some sense of 'focus' on the issues under consideration
and cohesion in their presentation. I owe him an enormous debt of gratitude.
Dr Derek Cooper, Computing & IT Services Manager (Denmark Hill), who helped
enormously in the quantitative analysis of the data, and Mrs Patsy Gardner of the computer
section of the Information Services Department for patiently inputting the large amount of
information from the respondents' questionnaires.
Ms Sarah Bignold, Research Assistant on the 'Attrition in Medicine' project, for her
contribution in interviewing, with me, some of the respondents and subsequently analysing the
transcripts, work which helped to explain the personality differences found in the job
satisfaction of the young doctors (see Chapter 15).
All the participants in the study, namely the 375 medical graduates from the King's College
School of Medicine and Dentistry, for their wonderful response to the questionnaire survey
and subsequent interviews involved in the research and to the medical staff at King's for
completing the questionnaires on the attributes of their specialties.
Dr Mary McCaulley, President, and Dr Charles Martin, Vice-President, Research &
Development, of the Center for Applications of Psychological Type (CAPT), Gainesville,
Florida, for their help and guidance in the approach taken with regard to the presentation and
interpretation of the 'type' data.
Ms Jamie Johnson, Research Librarian of CAPT, for her untiring support in conducting
literature searches and providing copies of publications without which it would not have been
possible to have related this research to previous relevant work in the field.
Dr Betsy Kendall, Chief Executive of Oxford Psychologists Press, Ltd., for her insightful
feedback on the draft questionnaire I produced to go to staff regarding the tasks they perform
daily in their specialties, and to the following who assisted in the validation of the results
derived from it, namely, Professor John Moxham, Deputy Dean of the GKT School of
Medicine and Professor of Respiratory Medicine, Mr John Rennie, Senior Lecturer
(Consultant) in Surgery, Dr John Philpott-Howard, Senior Lecturer (Consultant) in Medical
Microbiology and Dr Brian Fine, Senior Lecturer in General Practice and Primary Care.
Ms Christine Bell and the staff of the Library of the GKT School of Medicine for processing
innumerable interlibrary loan requests necessary to produce the background literature for this
thesis.
Ms Judy Allen, Dr Anita Houghton, Mr Nick Evans, Dr Anne Stephenson and Dr Peter
Watkins, for reading drafts and providing valuable feedback on different chapters of the
thesis.
Dr Mac Cochrane for participating in the mock viva voce held prior to submission of this
thesis which was very valuable preparation.
Last, but by no means least, Professor Adrian Eddleston, former Dean of the GKT School of
Medicine, for encouraging me to investigate further why a substantial minority of doctors
regretted their career choice and for facilitating my moving out of management in order to
pursue a research career. He also provided supporting letters to go out with the various
questionnaires which must have enhanced the response rate.
To the very many members of the medical education community and of the 'type' community
with whom I discussed my work at various stages of the research and who provided me with
helpful suggestions which informed the research design and subsequent interpretation of the
results.
Without the help received from all of the above, so willingly given, this project could not have
been completed.
April, 2002.� GILLIAN CLACK
4
ABSTRACT
A significant minority of British doctors have either left medicine or regret their career
choice. Until now most research has focused on working conditions in the modern NHS, the
role of individual differences not being examined. This thesis explores the concept of person-
environment fit, namely whether individuals' personality differences are related to their
specialty choice and job satisfaction. Differences between specialties should allow all
individuals to find a niche where they can thrive.
A sample of UK doctors completed questionnaires on their career progression, their
job satisfaction and the Myers-Briggs Type Indicator (MII3TI) to measure normal personality.
Semi-structured interviews were also conducted with a stratified sample to explore their
experiences of medical practice. Medical staff at the local University Hospital also provided
information on the tasks required in their daily practice which allowed 'personality profiles' of
the specialties to be constructed.
The personality preferences of those less satisfied with their career choice were then
compared with the task profiles of the specialties and the individuals working in them to see if
they were not congruent.
It was found that there were significantly more 'Sympathetic and Friendly SF types in
general practice (p<O.001) and 'Logical and Ingenious' NT types in hospital medicine
(p<O.001). Within hospital medicine, the 'Practical and Matter-of-Fact' ST types were
attracted to the diagnostic and support services (NS) whereas the 'Logical and Ingenious' NT
types were found in direct patient care (p<O.00I). There were also differences within
individual specialties.
When the type preferences of those less satisfied were compared to the tasks
performed and the people with whom they were working, no pattern emerged. However, it
was found that Feeling-deciders were significantly less satisfied than Thinking-deciders
(p<O.O1), irrespective of their specialty. The interview data provided ftirther insight, indicating
an organisational culture with a focus on the task rather than the people more in tune with the
approach of Thinking-deciders.
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TABLE OF CONTENTS
Page Numbers
Title page I
Acknowledgements 2-3
Abstract 4-5
Contents 6-14
List of Appendices 15-19
List of Tables 20-22
List of Figures.. 23-24
CHAPTER 1: INTRODUCTION 25-27
SECTION I: BACKGROUND AND CONTEXT OF THE RESEARCH
CHAPTER 2: WORKFORCE PLANNING�..�..�..�.. 28-32
2.1�Preamble�.�.�.�.�.�.�.�.�28
2.2�The modern National Health Service (NI-IS) ..�..�..�..�28-30
2.3�Planning the medical workforce�..�..�..�..�..�30-31
2.4�Summary�.�.�.�.�.�.�.�.�32
CHAPTER 3: MEDICAL STUDENT SELECTION ..�..�.. 33-42
3.1�Preamble�.�.�.�.�.�•.�.� 33
3.2�The 'good' doctor�..�..�..�..�..�..�..�33-35
3.3�The selection process ..�..�..�..�..�..�..�3 5-37
3.4�Academic background of medical students ..�..�..�..�37-3 8
3.5�Non-academic criteria..�..�..�..�..�..�..�38-41
3.6�Selecting students who will be happy as doctors�..�..�..�41-42
3.7�Summary�.�.�.�.�.�.�.�.�42
�
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Pa2e Numbers
CHAPTER 4: HOW DOCTORS ARE EDUCATED 43-51
�4.1�Preamble�..�..�.. 43
4.2�Undergraduate medical education 43-47
4.2.1 - The traditional medical course 43-45
4.2.2 - Tomorrow's Doctors' - a time for change 44-47
4.3�Postgraduate medical education (PGMIE) 47-50
4.4�Summary�..�..�.. 50-51
CHAPTER 5: WHAT CAN GO WRONG? 52-75
�5.1�Preamble�..�..�..�.. 52
5.2�Wastage during the undergraduate medical course 52
5.3�Wastage after qualification ..�.. 53-57
5.3.1 - Thescaleoftheproblem�.. 53-55
5.3.2 - Why do they leave? ..�.. 55-57
5.4�Doctors practising but dissatisfied with their career choice 57-72
5.4.1 - The scale of the problem�.. 57-59
5.4.2 - What are the reasons?�.. 59-72
5.4.2.1 - Structure and organisation of the profession 60-62
5.4.2.2 - Working environment 62-67
5.4.2.3 - Nature ofthejob.. 67-70
5.4.2.4 - Medicine dominates the individUls' life.. 70-72
5.4.2.5 - Other factors�.. 72
5.5�Mental ill health�..�..�.. 73
5.6�So why do they stay in?�..�..�.. 73-74
5.7�The role of personality�..�..�.. 74
5 .8�Summary�..�..�..�..�.. 74-75
�
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Page Numbers
SECTION II: THEORETICAL FRAMEWORKS
CHAPTER 6: THEORIES OF WORKER MOTIVATION,
JOB SATISFACTION AND THE CONCEPT OF PERSON!
ENVIRONMENT FIT�..�..�.. 76-89
6.1�Preamble�..�..�..�.. 76
6.2�Theories of worker motivation�.. 76-79
6.2.1 - Managerial approaches to motivation 77
6.2.2 - Individual motivation..�.. 78-79
6.3�Theories ofjob satisfaction�..�.. 79-81
6.4�Person-environment fit ('P x E fit') .. 81-88
6.5�Summary�..�..�..�.. 89
CHAPTER 7: CURRENT PERSONALITY THEORY AND
THE MYERS-BRIGGS TYPE INDICATOR (MBTI) 90-115
�7.1�Preamble�..�..�.. 90
7.2�Current personality theory and the 'Big Five'.. 90-92
7.3�The Myers-Briggs Type Indicator (MET!) 92-106
7.3.1 - Historical background 93-94
7.3.2 - The theory of 'psychological type' as measured
by the MBTI..�.. 94-99
7.3.2.1 - Extraverted v Introverted attitudc. 95-97
7.3.2.2 - Sensing v Intuitive perception 97
7.3.2.3 - Thinking v Feeling deciding 97-98
7.3.2.4 - Judging v Perceiving orientation 98-99
7.3.3 - Type dynamics�.. 99-103
7.3.4 - Type development .. 103-106
7.4�The MET! instrument�..�.. 106-111
7.4.1 - Reliability�..�..�.. 107-109
7.4.2 - Validity�..�..�.. 109-111
7.5�Myers-Briggs Type Indicator (MET!) and the 'Big Five' 111-114
7.6�Summary�..�..�..�.. 114-115
�
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Page Numbers
CHAPTER 8: MYERS-BRIGGS TYPE INDICATOR
AND MEDICAL SPECIALTY CHOICE 116-130
8.1�Preamble�..�..�.. 116-117
8.2�Medical student specialty preference 118-119
8.3�Graduate career destinations . - 120-129
8.3.1 - Studies conducted in the U.S.A. 120-129
8.3.2 - Studies conducted in the U.K. 129
8.4�Summary�..�..�.. 129-130
CHAPTER 9: MYERS-BRIGGS TYPE INDICATOR
AND JOB SATISFACTION�.. 131-148
9. 1�Preamble�..�..�.. 131
9.2�The impact of personality in the workplace 132-137
9.3�Organisational personality�.. 137-139
9.4�Research studies relating MIBTI type to job satisfaction. 139-146
9.4.1 - Studies outside health care 139-141
9.4.2 - Studies in the field of health care 141-146
9.5�General conclusions ..�.. 146-148
9.6 Summary�..�..�.. 148
SECTION III: DEVELOPMENT OF THE PROJECT
CHAPTER 10: DEVELOPMENT OF RESEARCH QUESTION • 149-151
�10.1�Preamble�..�..�..�..�.. 149-151
10.2�The research question�..�..�.. 150-151
CHAPTER ii: RESEARCH METHODOLOGY 152-157
�11. 1�Preamble�..�..�..�..�.. 152
11.2�The sample�.�.�-.�.�. •�152
11.3�Postal questionnaire�..�..�..�.. 152-153