Key factors influencing medical residency choice among medical graduates

BACKGROUND: Specialty choice plays a central role in shaping physicians' careers and influences the distribution and sustainability of the healthcare workforce. In Israel, persistent shortages in specific specialties and geographic regions highlight the need to better understand the motivations guiding specialty preferences. Identifying latent motivational dimensions provides a broad perspective on the interplay between multidimensional factors shaping specialty choice. METHODS: A cross-sectional survey was conducted among Israeli medical students in their final year and medical interns between July 2024 and January 2025. Participants completed an online questionnaire including demographic characteristics and motivational factors influencing specialty choice using 5-point Likert-scale items. Exploratory factor analysis based on polychoric correlations was performed to identify latent motivational dimensions. Factor associations with demographic characteristics and intended specialty were examined using proportional-odds ordinal logistic regression. RESULTS: A total of 527 trainees participated. Exploratory factor analysis identified three motivational dimensions: Interpersonal Factors, Career and Academic Development, and Lifestyle Aspects. All factors demonstrated acceptable internal consistency. No sex-based differences were observed for lifestyle or career and academic motivations, while women rated interpersonal considerations higher than men. Career and academic development motivations were stronger among trainees who studied abroad and among graduates compared with final-year students. Specialty-specific analyses showed that candidates intending surgical or obstetrics and gynecology specialties placed the greatest emphasis on career and academic development, while lifestyle considerations were more prominent among those aiming for pediatrics and psychiatry. Interpersonal motivations did not differ significantly across specialties. CONCLUSIONS: Specialty choice among Israeli medical trainees is shaped by distinct but interrelated motivational dimensions with important workforce implications. The shared importance of lifestyle considerations across sexes suggests that improvements in work-life balance may enhance recruitment across a wider range of specialties. Specialty-specific differences in career and academic motivations highlight the potential value of structured exposure during medical school rotations to research activity and academic career pathways, particularly in fields perceived as offering limited academic opportunities. Aligning training environments with trainee motivations may support recruitment to specialties in distress and contribute to long-term workforce sustainability.