The SCS had 783 eligible members, while 338 physicians completed the survey. Of these, 68 were initially excluded as they had not achieved the status of attending or consultant. In the end, a total of 270 questionnaires were analysed (270 of 783; 34%). Notably, not all questions were answered by all participants.
Among the included respondents, 70% (188) were male and 30% (80) were female. In terms of demographics, 83% (224) of respondents originated from the German speaking region of Switzerland, 13% (36) from the French speaking, 3% (9) from the Italian speaking, and <1% (1) from the Romansh speaking region.
Surgical experience of the respondents since completing medical school averaged 14.5 ± 5.4 years. In all, 93% (250/270) of respondents were board certified surgeons.
General analysis of all respondents
Overall, 28% (70/269) of respondents aspired to the position of chief physician, 53% (133/269) to that of senior physician, 12% (31/269) to attending, and 6% (16/269) of respondents to that of attending with special tasks.
With regards to the ultimate work environment, 44% (109/250) of respondents strived for a position at a cantonal hospital, 20% (51/250) preferred employment at a rural hospital, 19% (48/250) at a university hospital, and 14% (35/250) of respondents aspired to go into private practice. Nonclinical and other career paths were pursued in 3% (7/250) of cases.
In terms of chosen specialty, 50% (125/250) of participants identified visceral surgery, 22% (54/250) general surgery, 11% (27/250) traumatology, 8% (21/250) hand and plastic surgery, 7% (17/250) vascular surgery and 3% (6/250) thoracic surgery as their ultimate goal.
The average intended an 85% (minimum 10%, 1st IQR 80%, median 80%, 3rd IQR 100%, maximum 100%) part-time position and the intended average retirement age was 64 years (minimum 58, 1st IQR 62, median 65, 3rd IQR 65, maximum 72). With regard to task division, participants envisioned their work distribution as follows: 63% patient care, 16% teaching, 12% management, and 9% research. Notably, 8% (20/236) of participants felt very poorly prepared to take on managerial tasks, 23% (55/236) poorly, 36% (84/236) moderately, 25% (58/236) well and 8% (19/236) very well prepared. A total of 37% of participants (86/236) planned or had already completed some form of management training, while 41% (35/86) had completed an MBA and 26% (23/86) a CAS. Others favoured in-hospital courses or were uncertain.
1. Analysis according to the investigated genders
An overview of the results is shown in the supplemental table 1.
Career goals
Men aspired to the level of attending physician in 11% (19/169) of cases, attending with special tasks in 5% (9/169), senior physician in 46% (78/169), and chief physician in 37% (63/169). By contrast, 15% (12/79) of women strived for an attending position, 9% (7/79) attending with special tasks, 68% (54/79) senior physician, and 8% for (6/79) chief physician. Significant differences in career aspirations were seen at the level of senior physician (men 37% vs women 68%; p=0.002) and chief physician (men 37% vs women 8%; p<0.001).
Ultimate work environment
With regard to preferred work environment, men desired a cantonal hospital setting in 40% (68/169) of cases, a rural hospital in 23% (39/169) of cases, and a university hospital in 21% (36/169) of cases. The remaining 14% (23/169) chose private practice or, in 2% (3/169), a non-clinical or other career. A similar distribution was seen in female respondents. Here, 51% (40/79) planned to work at a cantonal hospital, 14 % (11/79) at a rural hospital, 15% (12/79) at a university hospital or at a private practice respectively, and 6% (4/79) chose to pursue a non-clinical or other career. No significant differences with regard to desired work setting emerged between the two genders examined.
Choice of specialty
A total of 14% (24/169) of men intended to work in the field of traumatology compared to 3% (2/79) of women (p=0.010). This was the only significant gender-specific difference to emerge. Men pursued careers in visceral surgery in 46% (78/169) of cases, whereas women did so in 59% (47/79) of cases. Further analyses showed that men chose general surgery in 21% (35/69) of cases; women in 23% (18/79). Men chose hand- and plastic surgery 8% (14/169) of the time while women did so in 9% (7/79) of cases. Similarly, men chose vascular surgery in 7% (12/169) of cases whereas women did so in 6% (5/79). In the current study, no women intended to train in thoracic surgery, whereas men chose the field in 4% (6/169) of cases.
Part-time vs. full-time employment
A significant difference in the desired future employment was observed between men (88.7 ± 14.7%) and women (81.7 ± 13.3%; p=0.001).
Desired retirement age
No difference in desired average retirement age emerged between men (64.6 ± 3.3 years; p=0.509) and women (64.3 ± 3.2 years).
Daily task distribution
No significant differences were seen with regard to respondents` ideals in terms of distribution of assigned daily tasks. Men expected to devote 61.8 ± 15.1% of their time to patient care, 16.4 ± 9.4% to teaching, 12.7 ±12.3% to managerial tasks and 9.1 ±7.9% to research. Similarly, women expected to spend 61.6 ± 15.1% of their time devoted to patient care, 17.4 ± 9.4% to teaching, 11.2 ± 7.5% to management, and 9.8 ±10.1% to research.
Preparation for managerial tasks
Men felt in 6% (10/159) very poorly, in 17% (27/159) poorly, in 35% (55/159) moderately, in 30% (48/159) well and in 12% (19/159) very well prepared to take on managerial tasks. In contrast, women felt in 13% (10/75) very poorly, 37% (28/75) poorly, 37% (28/75) moderately, 12% (9/75) well prepared. Interestingly, none of the women questioned felt very well prepared to take on managerial tasks. Indeed, women were significantly more likely to feel “poor” prepared than men (37% vs 17%; p=0.001). In this vein, men were significantly more likely to feel “very well” prepared to do so than women (12% vs 0%; p=0.004).
Planned management training
No significant differences emerged with regard to planned management training: men considered training in 40% (63 of 159) of cases and women in 29% (22 of 75; p=0.167) of cases.
2. Analysis according to experience
An overview of results is shown in supplemental table 2.
Career goals
With regard to ultimate career goals, “newcomers” aspired in 11% (9/79) to attending, in 4% (3/79) to attending with special tasks, in 67% (53/79) to senior physician, and in 18% (14/79) to chief physician. “Advanced“ respondents tended to identify their ultimate career goal as attending in 12% (11/89) of cases, attending with special tasks in 11% (10/89) of cases, senior physician in 55% (49/89), and chief physician in 21% (19/89) of cases. Finally, the ultimate career goals of “senior” respondents were divided as follows: 13% (11/82) attending, 4% (3/82) attending with special tasks, 38% (31/82) senior physician, and 45% (37/82) chief physician. Significant differences were seen between respondents when it came to the position of senior physician (“newcomer”: 67% vs “advanced”: 55% vs “senior”: 38%; p<0.001) and chief physician (“newcomer”: 18% vs “advanced”: 21% vs “senior”: 45%; p<0.001).
Ultimate work environment
“Newcomers” were, with 58% (46/79), most likely to aspire to employment in a cantonal hospital. Otherwise, they identified a university hospital in 18% (14/79), a rural hospital in 13% (10/79), private practice in 9% (7/9), and nonclinical or other careers in 2% (2/79) of cases as their chosen work environment. “Advanced” respondents strived for employment in 37% (33/89) of cases at a cantonal hospital, in 26% (23/89) at a university hospital, in 22% (20/89) at a rural hospital, in 11% (10/89) at a private practice, and in 3% (3/83) of cases in a nonclinical or other setting. “Seniors” saw their ultimate ideal work setting as follows: 37% (30/82) a cantonal hospital, 26% (21/82) a rural hospital, 22% (18/82) in private practice, 13% (11/82) a university hospital, and 2% (2/82) in a nonclinical or other setting. When compared, the only significant difference that emerged was in the number of respondents who identified a cantonal hospital (“newcomer”: 58% vs “advanced”: 37% vs “senior”: 37%; p=0.007) as their ideal place of employment.
Choice of speciality
Regarding specialties, “newcomers” chose visceral surgery in 61% (48/79) of cases, general surgery in 18% (14/79), hand and plastic surgery in 9% (7/79), traumatology in 8% (6/79), and in 5% (4/79) vascular surgery. None chose thoracic surgery. “Advanced” responders selected visceral surgery in 49% (44/89) of cases, general surgery in 22% (20/89), hand and plastic surgery in 11% (10/89), vascular surgery in 8% (7/89), traumatology in 7% (6/89), and thoracic surgery in 2% (2/89). “Seniors” chose visceral surgery in 40% (33/82), general surgery in 24% (20/ 82), traumatology in 18% (15/82), vascular surgery in 7% (6/82), and both hand and plastic surgery and thoracic surgery in 5% (4/82) of cases. Significant differences were seen in the likelihood of choosing a career in visceral surgery (“newcomer”: 61% vs “advanced”: 49% vs “senior”: 40%; p=0.034) and traumatology (“newcomer”: 8% vs “advanced”: 7% vs “senior”: 18%; p=0.028).
Part-time vs. full-time employment
With regard to future part-time or full-time employment, there were no statistically significant differences depending on the seniority of the respondent. “Newcomers” envisioned a future part-time employment of 85.4 ± 12.2 % (median 80%), “advanced” respondents of 85.9 ± 13.3 % (median 80%), and “senior” respondents of 87.7 ± 18.8 % (median 100%).
Desired retirement age
“Newcomers” envisioned a retirement age of 63.8 ± 3.3 years,” advanced” respondents of 64.2 ± 3.3 years, and “senior” respondents of 65.3 ±3.1 years. The median in each group was 65 years. Significant differences were seen between “newcomers” and “senior” respondents (63.8 years vs 65.3 years; p=0.004) and between “advanced” and “senior” respondents (64.2 years vs 65.3 years; p=0.004).
Daily task distribution
The desired distribution of daily tasks was similar in all groups. The only statistically significant difference was seen with regard to research. Here, “newcomers” (11 ± 8.9%) desired significantly more time than “advanced” responders (9.8 ± 9.8%; p=0.001) or “senior” responders (6.8 ± 6.3%; p=0.02). “Newcomers” envisioned devoting 60.5 ± 11.6% of their time to patient care, 18 ± 8.1% to teaching, 11 ± 8.9% to research, and 10.5 ± 7.7% to management. “Advanced” responders hoped to devote 61 ± 16.5% of their time to patient care, 16 ± 8.6% to teaching, 13.1 ± 11.6% to management, and 9.8 ± 9.8% to research. Finally, “senior” respondents desired a task division as follows: 62.2 ± 19.2% patient care, 15.5 ± 11.5% teaching, 12.8 ± 13.1% management, and 7 ± 6.3% research.
Preparation for managerial tasks
“Newcomers” felt in 31% of cases (24/77) poorly and in 1% (1/77) very well prepared to take on managerial tasks, whereas “advanced” responders felt poorly prepared in 28% (24/86) of cases and in 9% (8/86) very well prepared. “Senior” respondents felt in 10% (7/73) poorly and 14% (10/73) very well prepared to take on managerial tasks. Significant differences emerged between the groups of respondents who felt poorly (“newcomer”: 31% vs “advanced”: 28% vs “senior”: 10%; p=0.003) and very well (“newcomer”: 1% vs “advanced”: 9% vs “senior”: 14%; p=0.018) prepared to take on a management role.
Planned management training
“Senior” respondents tended to have significantly less management training planned (21%; 15/73) than “advanced” respondents (42%; 36/86) or “newcomers” (45%; 35/77) (p=0.003).
3. Analysis according to career goals
An overview of the results is shown in supplemental table 3.
Ultimate work environment
Further investigation showed that participants with the ultimate career goal of attending desired in 35% (11/31) of cases to work at a cantonal hospital, in 23% (7/31) in a private practice, in 19% (6/31) at a rural hospital, in 12% (4/31) in a non-clinical or other career, and in 10% (3/31) at a university hospital. Respondents who strived to become an attending with special tasks sought in 50% (8/16) of cases employment at a cantonal hospital, in 25% (4/16) a rural hospital, in 13% (2/16) in a private practice, and in 6% (1/16) in either a university hospital or non-clinical/other career. Finally, senior physicians favoured cantonal hospitals in 49% (65/133) of cases, rural hospitals in 21% (28/133), university hospitals in 17% (23/133), private practice in 12% (16/133) and 1% (1/133) had other career goals. Individuals whose ultimate career goal was chief physician sought employment in 36% (25%70) of cases at a cantonal hospital, in 30% (21/70) at a university hospital, in 19% (13/70) at a rural hospital, in 14% (10/70) at a private practice, and in 1% (1/70) other forms of employment. Overall, significant differences were seen in the choice to seek employment at a university hospital (attending: 10%, attending with special tasks: 6%, senior physician: 17%, chief physician: 30%; p=0.028) and the pursuit of a non-clinical or other career (attending: 6%, attending with special tasks: 6%, senior physician: 0%, chief physician: 0%; p=0.004).
Choice of speciality
Those who aspired to achieve the ultimate status of attending chose visceral surgery in 42% (13/31) of cases, general surgery in 29% (9/31), and traumatology, hand and plastic surgery, and vascular surgery in each 10% (3/31) of cases, none chose to specialise in thoracic surgery. Attendings with special tasks chose visceral surgery in 44% (7/16) of cases, general surgery in 25% (4/16), traumatology in 19% (3/16) hand and plastic surgery in 13% (2 /16). Of those aspiring to this level none chose specialities in vascular or thoracic surgery. Aspiring senior physicians chose visceral surgery in 53% (71/133) of cases, general surgery in 23% (31/133), traumatology in 10% (13/133), vascular surgery in 7% (9/133), hand and plastic surgery in 6% (8/133) and thoracic surgery in 1% (1/133). Aspiring chief physicians chose visceral surgery in 49% (34/70) of cases, general surgery in 14% (10/70), traumatology and hand and plastic surgery in each 11% (8/70) and thoracic and vascular surgery in each 7% (5/70) of cases.
With regard to specialties, the only significant difference was seen in the desire to pursue a career in thoracic surgery (attending: 0%, attending with special tasks: 0%, senior physician: 1%, chief physician: 7%; p=0.024).
Part-time vs. full-time employment
The average intended a part time employment of 84.5 ± 15.3% (median 80%) for those whose ultimate goal was attending, 87.1 ± 15.2% (median 95%) for attending with special tasks, 83.9 ± 15.7% (median 80%) for senior physician, and 91.6 ± 11.7% (median 100%) for chief physician. Significant differences emerged between attending (84.5 ± 15.3%) and chief physician (91.6 ± 11.7%; p=0.013).
Desired retirement age
Aspiring attendings envisioned a retirement age of 64.8 ± 2.8 years, attendings with special tasks 63.9 ± 3.2 years, senior physicians 64.1 ± 3.1 years, and chief physicians 65.1 ±3.7 years. The difference in planned age of retirement between those aspiring to the role of senior and chief physicians (64.1 years vs 65.1 years; p=0.049) was significant. The median was 65 years of age in each group.
Daily task distribution
Those who ultimately aspired to the role of attending expected to devote 60.5 ± 21.7% of their time to patient care, 16.5 ± 21.5% to management, 15.2 ± 11.3% to teaching, and 7.8 ± 7.5% to research. Attendings with special tasks sought to spend 59.7 ± 16.8% of their time devoted to patient care, 17 ± 5.7% to teaching, 12.1 ±13.2% to research, and 11.2 ± 7.7% to management. Senior physicians hoped to devote 62.7 ± 14.0% of time to patient care, 17.9 ± 10.6% to teaching, 11.2 ± 8.1% to management, and 8.6 ± 8.6% to research. Chief physicians imagined their daily task distribution as follows: 61 ± 12.9% patient care, 14.7 ± 5.6% teaching, 13.4 ± 9.2% management, and 10.8 ± 7.6% research. Subanalysis showed a significant difference in the percentage of time senior and chief physicians respondents expected to devote to teaching 17.9 ± 10.6% vs.14.7 ± 5.6%, respectively (p=0.025), as well as in the percentage of time dedicated to management between attendings (16.5 ± 21.5%) and senior physicians (10.8 ± 8.1%; p=0.02) and between senior (10.8 ± 8.1%) and chief physicians (13.4 ± 9.2%; p=0.048).
Preparation for managerial tasks
Participants with the ultimate career goal of attending felt in 13% (4/30) very poorly, in 20% (6/30) poorly, in 33% (10/30) moderately, in 30% (9/30) well, and in 3% (1/30) very well prepared to take on managerial tasks. Aspiring attendings with special tasks felt in 6% (1/16) very poorly, in 19% (3/16) poorly, in 31% (5/16) moderately, in 31% (5/16) well and in 13% (2/16) very well prepared to do so. Aspiring senior physicians felt in 10% (12/126) very poorly, in 29% (36/126) poorly, in 38% (48/126) moderately, in 20% (25/126) well, and in 4% (5/126) very well prepared. Finally, those aspiring to chief physicians felt in 5% (3/64) very poorly, in 16% (10/64) poorly, in 33% (21/64) moderately, in 30% (19/64) well and in 17% (11/64) very well prepared.
Regarding subjective preparation for managerial tasks, a significant difference was seen only in those that felt very well prepared (attending: 3% vs attending with special tasks: 13% vs senior physician: 4% vs chief physician: 17%; p=0.001).
Planned management training
A total of 27% (8/30) of participants, whose ultimate career goal was attending planned to take some form of management training, whereas 13% (2/16) of attendings with special tasks, 37% (46/126) of senior physicians, and 47% (30/64) of chief physicians (p=0.042) did.
Association of future workplace and aspired speciality
Results are displayed in table 1.
Aspiring general surgeons tended to choose rural hospitals (41%; p<0.01) as their desired work environment, whereas aspiring visceral surgeons tended to choose university hospitals (69%; p=0.43). Furthermore, aspiring hand- and plastic surgeons pursue to work in a private practice (29%; p<0.001).