• Michael J Goldacre, L Laxton, and T W Lambert.
• UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF. michael.goldacre@dphpc.ox.ac.uk
• BMJ. 2010 Jan 1;341:c3199.

ObjectiveTo report on doctors' early choices of specialty at selected intervals after qualification, and eventual career destinations.DesignQuestionnaire surveys.SettingUnited Kingdom.ParticipantsTotal of 15 759 doctors who qualified in 1974, 1977, 1983, 1993, and 1996, and their career destinations 10 years after graduation.Results15 759 doctors were surveyed one and three years after graduation and 12 108 five years after graduation. Career preferences at years 1, 3, and 5, and destinations at 10 years, were known for, respectively, 64% (n=10 154), 62% (n=9702), and 61% (n=7429) of the survey population. In the 1993 and 1996 cohorts, career destinations matched with year 1 choices for 54% (1890/3508) of doctors in year 1, 70% (2494/3579) in year 3, and 83% (2916/3524) in year 5. Corresponding results for the earlier cohorts (1974-83) were similar: 53% (3310/6264), 74% (4233/5752), and 82% (2976/3646). The match rates varied by specialty; for example, the rates were consistently high for surgery. Career destinations matched with year 1 choices for 74% (722/982) of doctors who specified a definite (rather than probable or uncertain) specialty choice in their first postgraduate year. About half of those who chose a hospital specialty but did not eventually work in it were working in general practice by year 10.ConclusionsTen years after qualification about a quarter of doctors were working in a specialty that was different from the one chosen in their third year after graduation. This stayed reasonably constant across graduation cohorts despite the changes in training programmes over time. Subject to the availability of training posts, postgraduate training should permit those who have made early, definite choices to progress quickly into their chosen specialty, while recognising the need for flexibility for those who choose later.

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