The die-hards, negotiators and migrants: Portraits of doctors' career pathways through specialisation.

Introduction: Global workforce shortages in medical specialties strain healthcare systems, jeopardising patient outcomes. Enhancing recruitment strategies by supporting professional identity (PI) development may be one way to address this workforce gap-yet little research has explored this topic. The goal of the current study was to explore specialty-specific recruitment through considering PI. As proposed causes of workforce shortages in anatomical pathology (AP) bear similarities to many other specialties, this study uses the field of AP as a model for specialist PI development and asks: (1) why, how and when do doctors choose to pursue AP training and (2) what can be learned from this for recruitment to AP and other specialties?

Methods: A qualitative research approach was undertaken using narrative inquiry. Interviews with junior doctors interested in AP, AP registrars and AP consultants from Australia and New Zealand were interpreted as stories via 're-storying'. Narrative synthesis of participants' collective stories identified chronological key events (i.e. 'turning points') in choosing AP.

Results: Narrative synthesis resulted in identification of three portraits entering medical specialist training: (1) die-hards, deciding upon initial exposure; (2) negotiators, choosing after comparing specialties; and (3) migrants, seeking to move away from non-pathology specialties. The negotiators and migrants cemented their decision to pursue AP as a postgraduate doctor, whereas the die-hards made this decision during medical school.

Conclusions: Given the similarities in portrait traits between AP and other specialties across the literature, our results suggest ways to support specialty recruitment using PI development. We propose a medical specialist recruitment framework to support the PI development of doctors with die-hard, negotiator and migrant traits. Use of this framework could enhance current specialty-specific recruitment approaches, particularly in fields challenged by workforce shortages.