Am J Psychiatry 156:9, September 1999 1397

Attitudes Toward Psychiatry as a Prospective Career

Among Students Entering Medical School
David Feifel, M.D., Ph.D., Christine Yu Moutier, M.D., and Neal R. Swerdlow, M.D., Ph.D.
Objective: The number of U.S. medical graduates choosing careers in psychiatry is in
decline. In order to determine whether this disinclination toward psychiatry occurs before
versus during medical school, this study surveyed medical students at the start of their
freshman year. Method: Within the first 2 weeks of medical training, 223 freshman medical
students from three Southwestern medical schools were surveyed with a questionnaire de-
signed to assess their perceptions of careers in various specialties. Results: Responses
suggest that new medical students most strongly value aspects of doctoring that seem to
comport well with the actual practice of psychiatry: desire for interpersonal contact, helping
patients, attractive lifestyle, and challenging work. However, these students begin their med-
ical training viewing a career in psychiatry as distinctly and consistently less attractive than
other specialties surveyed. More than one-quarter of the new medical students had already
definitively ruled out a career in psychiatry. New medical students rated psychiatry signifi-
cantly lower than each of the other specialties in regard to the degree to which it was a sat-
isfying job, financially rewarding, enjoyable work, prestigious, helpful to patients, dealing
with an interesting subject matter, intellectually challenging, drawing on all aspects of med-
ical training, based on a reliable scientific foundation, expected to have a bright and interest-
ing future, and a rapidly advancing field of understanding and treatment. Conclusions:
Contrasting these results with previous studies suggests that an erosion has occurred over
the past two decades in the attitudes that new medical students hold toward psychiatry.
The authors suggest that some of the negative attitudes are based on objectifiably false be-
liefs that should be actively targeted for remediation within the medical school curriculum.
(Am J Psychiatry 1999; 156:13971402)
Notwithstanding some cyclical variation, there has
been a distinct general decline over the last quarter
century in the percentage of U.S. medical students
choosing to specialize in psychiatry (1). The consistent
rates of 7% to 10% per year in the years following
World War II began to fall in the early 1970s and now
have declined to approximately 3% (1). During the
last decade alone (19881998) the number of U.S.
medical students matching to psychiatric residencies
has declined by 42.5% (2). Several hypotheses have
been posited to account for this decline (1, 3). It is not
known whether this decline indicates that medical stu-
dents entering medical training are less attracted to
psychiatry, or whether the medical school experience is
increasingly deterring interest in psychiatry, or whether
both processes occur.
To differentiate deterring factors that exist prior to
medical school from those that develop during medical
school, it is important to assess the attitudes of U.S.
medical students who are naive of the medical school
experience. In the early 1970s, Fishman and Zimet (4)
reported that 13% of freshmen medical students at
two U.S. medical schools indicated that psychiatry was
their top specialty choice for vocation. No comparable
study has been conducted since that time. In the
present study, we surveyed freshman medical students
at three southwestern United States medical schools
within the first 2 weeks of their freshman medical year.
METHOD
Medical students entering their freshman year in 1994 at three
medical schools (University of California, San Diego; University of
California, Irvine; and University of Texas at Houston) were asked
to participate in a study being conducted to assess the attitudes of
medical students toward various medical specialties. Willing partici-
pants anonymously completed a survey regarding their attitudes to-
Received Sept. 9, 1996; revisions received Nov. 5, 1998, and
Feb. 19, 1999; accepted March 17, 1999. From the Department of
Psychiatry, University of California, San Diego. Address reprint
requests to Dr. Feifel, Department of Psychiatry, UCSD, 200 West
Arbor Dr., San Diego, CA 92103-8620; dfeifel@ucsd.edu (e-mail).
1398 Am J Psychiatry 156:9, September 1999
PSYCHIATRY AS A PROSPECTIVE CAREER
ward careers in various medical specialties. In each case the survey
was conducted during the freshman orientation period or within the
first week of classes.
The survey was developed by two of the authors (D.F. and
C.Y.M.) and was based on questionnaires developed by others for
similar purposes (3, 5, 6). The survey required 1520 minutes to
complete and consisted of 24 items; the majority of the items were in
a 5-point Likert scale format, whereas some were in an open-ended
format. (The questionnaire is available on request from Dr. Feifel).
The items explored five areas:
1. The demographic backgrounds of the student;
2. Which generic factors students considered important in their
choice of a specialty;
3. The degree to which students were considering possible careers
among various medical specialties (family practice, internal medi-
cine, pediatrics, surgery, obstetrics/gynecology, and psychiatry);
4. The degree to which students found various specialties (internal
medicine, surgery, pediatrics, and psychiatry) attractive as careers
with regard to the following aspects: financial reward, lifestyle, job
satisfaction, enjoyable work, degree to which patients are helped,
prestige, interesting subject, challenging work, drawing on all as-
pects of medical training, reliable scientific basis, rapidly advancing
understanding and treatment of illness, bright and interesting future;
5. Their estimates of the degree to which others (e.g., classmates,
physicians, community) respected the skills of physicians in various
specialties (internal medicine, surgery, pediatrics, and psychiatry).
For each applicable item in this questionnaire students were asked
to provide a response for several specialties, including psychiatry.
Students were blind to the specialty of the investigators and the spe-
cialty focus (psychiatry) of the study. The questionnaire was distrib-
uted and collected through the office of the dean of each medical
school.
Ratings of attractiveness of each specialty with regard to various
aspects were treated as continuous data (7) and were analyzed by us-
ing a two-tailed, repeated measures analysis of variance (ANOVA),
with medical school as a between-subject grouping factor and spe-
cialty as within-subject grouping factor. A significant overall
ANOVA was followed by individual pairwise comparisons that used
a two-tailed Students t test corrected by the Bonferroni method for
multiple comparisons. Other ratings by students were treated as de-
scriptive; these included which generic factors they considered im-
portant in their choice of a specialty, the degree to which they were
considering various medical specialties as possible careers, and their
estimates of the degree to which others (e.g., classmates, physicians,
community) respected the skills of physicians in various specialties.
RESULTS
The rates of response were 119 (60%) from the Uni-
versity of Texas at Houston; 34 (40%) from the Uni-
versity of California, Irvine; and 70 (56%) from the
University of California, San Diego. The total group
size of 223 constitutes a 52% response rate across all
three schools.
Table 1 displays the demographic characteristics of
the subjects in each of the three freshman classes. The
freshman class of the University of Texas at Houston
was composed of notably fewer Asian Americans than
were the classes at the University of California, Irvine
and San Diego, and had notably fewer students describ-
ing themselves as having no religious affiliation. Other-
wise, the subjects who responded did not appear to dif-
fer significantly in age, gender distribution, size of
community of origin, or college majors across the three
freshman classes. A comparison of attitudes of medical
students toward various specialties and aspects of ca-
reer choice revealed no significant differences across
schools for any of the aspects queried. As a result, data
averaged across all three schools are presented.
TABLE 1. Demographic Characteristics of Medical Students (N=223) Entering Their Freshman Year at Three Medical Schools
Characteristic
University of California,
San Diego (N=70)
a
University of California,
Irvine (N=34)
a
University of Texas
at Houston (N=119)
a
N % N % N %
Gender
Male 41 58.6 19 54.5 70 58.5
Female 29 41.4 15 45.5 49 41.5
Ethnicity
Caucasian 32 45.7 18 52.9 81 68.0
African American 2 3.6 1 2.9 3 2.5
Asian American 19 27.1 8 23.5 6 5.0
Other 17 23.6 7 20.6 29 24.5
Religious background
Protestant 16 22.9 5 14.7 31 26.0
Catholic 14 20.0 11 32.3 52 43.7
Jewish 5 7.1 4 11.8 7 5.9
Other 9 12.9 7 20.6 15 12.6
No affiliation 26 37.1 7 20.6 14 11.8
Community size
>500,000 26 37.1 16 47.1 65 54.6
100,000500,000 15 21.5 9 26.5 15 12.6
10,00099,000 25 35.7 7 20.6 23 19.3
<10,000 4 5.7 2 5.9 16 13.4
College major
Biological sciences 46 65.8 22 64.7 72 60.5
Psychology 7 10.0 2 5.9 10 8.4
Physical sciences/math 5 7.1 6 17.4 9 7.5
Other social sciences 7 10.0 2 5.9 14 11.8
Liberal arts/humanities 5 7.1 2 5.9 14 11.8
Business 0 0.0 0 0.0 0 0.0
a
The mean ages of the students on entering medical school were as follows: University of California, San Diego, 23.2 years; University of
California, Irvine, 25.6 years; and University of Texas at Houston, 23.3 years.
Am J Psychiatry 156:9, September 1999 1399
FEIFEL, MOUTIER, AND SWERDLOW
Students were asked to rate the degree to which each
of three aspects of medicine interested them (1=not at
all, 5=very much). Students in all three schools en-
dorsed similar interests, ranking interpersonal interac-
tions with patients the highest (rating of 4.7), the diag-
nosis and treatment of disease second (rating of 4.5),
and scientific research third (rating of 3.3). Students
were also asked to rate the importance of five possible
factors in choosing a specialty as a vocation. They
mostly strongly rated the ability to help patients (rating
of 4.7), followed by interesting and challenging work
(rating of 4.6), lifestyle factors (rating of 4.4), financial
reward (rating of 3.2), and prestige (rating of 2.7).
Figure 1 illustrates the degree to which freshman
medical students were considering various specialties
as prospective career options. For each specialty ap-
proximately one-third of the students indicated that
they had not developed a strong opinion. Among the
remaining respondents, consideration of specialties
differed greatly, with psychiatry ranking poorest by
any ordinal measure. Only one student of 221 (0.5%)
identified psychiatry as the career of choice, and only
16 (7.2%) considered it a strong possibility; these were
the smallest numbers among any of the specialties in
both of these categories. Similarly, 78 (35.3%) consid-
ered it unlikely that they would choose psychiatry as a
career, and 60 (27.1%) had already definitively ruled it
out (no way); these were the highest proportions
among any of the specialties surveyed for both of these
categories.
A review of the open responses given by students
who definitively ruled out a career in psychiatry, a pri-
ori, suggests that two major themes contributed to
their position. Approximately 25% (N=35) of those
who responded identified the patient population as a
major aversive factor, citing the undesirability and
emotional drain of interacting with psychologically
impaired patients. Approximately 60% of respondents
(N=85) identified the field itself as a major aversive
factor, citing a lack of scientific foundation or a lack of
clinical efficacy of psychiatric treatments or both,
which made a career in psychiatry seem excessively
frustrating. The remainder (approximately 15%
[N=21]) simply cited a total lack of interest in the field.
Ratings of attractiveness in regard to various career
aspects of the four specialtiesinternal medicine, sur-
gery, psychiatry, and pediatricsrevealed significant
differences across specialties for all aspects measured
(table 2). Individual pairwise comparisons revealed
that students rated psychiatry significantly lower than
each of the other three specialties in regard to the de-
gree to which it was a satisfying job, enjoyable work,
prestigious, helpful to patients, dealing with an inter-
esting subject matter, intellectually challenging, draw-
ing on all aspects of medical training, based on a reli-
able scientific foundation, expected to have a bright
and interesting future, and a rapidly advancing field of
understanding and treatment. Psychiatry was rated as
significantly less attractive than internal medicine and
surgery, but not pediatrics, in regard to financial re-
ward. Psychiatry was rated as significantly more at-
tractive than surgery, and no different from internal
medicine or pediatrics, with respect to lifestyle.
When asked to estimate the degree to which they,
their family, their classmates, and other physicians re-
spected the skills and knowledge of physicians in each
specialty, students rated psychiatrists substantially
lower than each of the other three types of specialists
(figure 2).
DISCUSSION
While the response rate achieved in this study (52%)
is comparable to that of other studies of medical stu-
dent attitudes by survey (3, 6), it represents a limita-
tion regarding the ability to generalize from these re-
sults. On the other hand, the lack of significant
differences in the responses across the three schools
surveyed supports the generalizability of these find-
ings. The results suggest that medical students bring to
their medical training a very negative view of psychia-
try, compared to other specialties. The consistency of
psychiatrys terminal ranking in virtually all areas sur-
veyed indicates that this field continues to be perceived
as outside the mainstream of medical practice. This is
consistent with findings from previous studies of the
attitudes of medical students at various stages of their
medical education, which reveal a general negative at-
titude toward psychiatry (3, 6). The present study
demonstrates that these negative views are formed be-
fore formal medical training.
While differences in research methodology make
longitudinal comparisons of medical student attitudes
difficult, two previous studies of medical students early
in their freshman year serve as interesting comparisons
to this study. In the early 1970s, Fishman and Zimet
(4) surveyed freshmen medical students at the begin-
ning of the academic year at two medical schools, and
FIGURE 1. Degree to Which New Medical Students (N=223)
Considered Careers in Various Specialties
F
a
m
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y

p
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No way
Unlikely No opinion
Strong possibility
Chosen
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1400 Am J Psychiatry 156:9, September 1999
PSYCHIATRY AS A PROSPECTIVE CAREER
they found that 13% of the students identified psychi-
atry as their top specialty choice for vocation. A de-
cade later, Friedman and McGuire (5) assessed the
freshman medical class at the University of California,
Irvine, within the first half of the academic year and
found that 11% of the students were very interested in
psychiatry as a possible career and that 28% expressed
a negative interest. By comparison, our data indicate
that less than 8% of the students were very interested
in psychiatry and that of these, only 0.5% considered
it their top choice, whereas 62% of the students ex-
pressed a negative consideration of psychiatry as a ca-
reer (unlikely or no way). On the basis of these com-
parisons, it seems that there has been a distinct decline
over the past two decades in the attraction of freshman
medical students to careers in psychiatry. This view is
consistent with a prematriculation survey conducted
by the Association of American Medical Colleges (8),
which revealed that first-year medical students in 1992
were less likely to plan psychiatric careers than were
first-year medical students in 1987 and 1988. Such re-
sults support the admissions hypothesis (3) for the
decline in medical graduates entering psychiatric train-
ing, which posits that students entering medical school
are increasingly less inclined to positively view careers
in psychiatry. Little is known regarding the factors that
influence the specialty choice of psychiatry before
medical school. Zimny and Sata (9) evaluated several
possible factors retrospectively and found that psy-
chology-based college courses, mental health work ex-
perience, and experience with someone having a psy-
chiatric disorder were the pre-medical school factors
that led to the most positive view of psychiatry.
As for the apparent erosion of interest in psychiatry
among new medical students, several possible reasons
exist. Undergraduates inclined toward professional ca-
TABLE 2. Ratings of Attractiveness of Career Aspects of Four Medical Specialties by Medical Students (N=223) Entering Their
Career Aspect
Internal Medicine Surgery Pediatrics
Rating
a
Effect
Size
b
Rating
a
Effect
Size
b
Rating
a
Effect
Size
b
Mean SD Mean SD Mean SD
Financial reward 2.46 0.66 0.25 1.65 0.78 1.00 2.78 0.81 0.14
Lifestyle 2.48 0.81 0.11 3.41 1.20 0.49 2.31 0.96 0.23
Job satisfaction 1.89 0.75 0.88 2.03 0.98 0.70 1.66 0.81 1.04
Interesting subject matter 1.77 0.77 0.58 1.67 0.83 0.63 1.99 0.96 0.41
Intellectually challenging 1.69 0.72 0.47 1.71 0.84 0.43 2.08 0.95 0.13
Prestige among medical community 2.32 0.74 0.71 1.70 0.77 1.15 2.60 0.86 0.47
Prestige among public 2.21 0.77 0.73 1.65 0.81 1.09 2.20 0.80 0.73
Degree to which patients are helped 1.80 0.75 0.88 1.70 0.75 0.93 1.67 0.75 0.97
Training aspects drawn on 1.62 0.75 1.29 2.31 1.01 0.74 1.88 0.89 1.16
Advancing understanding and treatments 1.88 0.75 0.39 1.73 0.77 0.84 2.17 0.83 0.52
Bright and interesting future 1.89 0.83 0.70 1.92 0.86 0.64 2.07 0.90 0.53
Based on scientific foundation 1.85 0.74 0.98 1.88 0.78 0.88 1.89 0.80 0.94
Enjoyable work 1.91 0.78 0.76 2.22 1.13 0.51 1.85 0.98 0.78
Association with colleagues in specialty 2.03 0.77 0.59 2.33 1.11 0.30 2.09 0.95 0.55
a
1=very attractive, 2=attractive, 3=neutral, 4=not attractive, 5=extremely unattractive.
b
Effect size of individual comparison to psychiatry. All effect sizes reflect a significant difference from psychiatry (p<0.01; post hoc two-
tailed Students t test with Bonferroni correction for multiple comparisons).
FIGURE 2. Degree to Which New Medical Students (N=223) Respected and Estimated the Respect by Other Physicians, Class-
mates, and Family Members Given to Physicians in Various Specialties
Much Average Little
I
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Self Classmates Physicians Family
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Am J Psychiatry 156:9, September 1999 1401
FEIFEL, MOUTIER, AND SWERDLOW
reers in mental health may be increasingly choosing
other, nonmedical, clinical training paths to this goal
(10). Similarly, shifts over the past two decades in the
demographic characteristics of medical students could
be resulting in a greater proportion of medical students
from sociocultural backgrounds less favorably inclined
toward careers in psychiatry (11, 12). Perhaps the
medical school selection process has become increasing
biased against selecting candidates with the educa-
tional backgrounds (e.g., humanities) that may charac-
terize the most positively inclined applicants. Finally,
perhaps medical students entering medical school are
merely reflecting an increasingly hostile attitude held
by contemporary American society toward psychiatry
and psychiatrists (1316).
Students reported significantly less respect for the
professional skills of psychiatrists and also estimated
that their classmates possessed even less respect for psy-
chiatrists and that physicians at their medical school
held psychiatrists in even lower esteem. It is very un-
likely that within their first few days of medical school,
these students had any exposure to specific attitudes re-
garding psychiatry held by either their classmates or the
medical teaching faculty. Beginning medical students
appear to perceive that the process involved in becom-
ing a physician will move them toward an even more
negative view of psychiatry.
Attitudes assessed in this survey reflect primarily a
subjective value system and cannot objectively be
deemed accurate or inaccurate. However, some of
these attitudes appear to reflect inaccurate or incom-
plete knowledge, and it is these negative attitudes that
may be corrected through the course of medical educa-
tion. For example, students perceive that psychiatric
treatments are less effective than those available in
other specialties. There is sufficiently strong scientific
evidence available to counter this perception and to
suggest that the effectiveness of psychiatric treatments,
on the whole, is equal to or superior to that of conven-
tional treatments in other specialty fields (17). On the
other hand, patients with diseases that are difficult to
treat are found in all medical practices, and the current
data suggest that students entering medical school
view negatively the prospect of working with these
populations. This points to a need for increased teach-
ing about such issues across specialty boundaries dur-
ing medical school.
Other beliefs about psychiatry seem to be due to er-
roneous or insufficient knowledge. For example, stu-
dents only weakly endorsed the belief that psychiatry is
a rapidly advancing field and saw it as having a less
bright and less interesting future than all the other spe-
cialties surveyed. It is hard to identify a specialty that
in the last decade has seen an explosion in the under-
standing and treatment of illness in its purview compa-
rable to that in the field of psychiatry. Considering
pharmacological treatments alone, the advent of newer
antidepressants (e.g., serotonin uptake inhibitors and
atypical antidepressants), mood stabilizers (anticon-
vulsants), and atypical antipsychotics has revolution-
ized the standard pharmacological treatment of mental
illness.
Studies of the stability of specialty choices among
medical students suggest that a large proportion of
medical students will change their specialty prefer-
ences from the freshman to senior years (1820). Evi-
dence indicates that attitudes toward any specialty can
be improved as a result of a skillful and enthusiastic
presentation of that specialty (21, 22). This suggests
that medical school experience has a significant effect
on shaping ultimate career choices and that negative a
priori attitudes of new medical students toward psy-
chiatry can be ameliorated. Negative beliefs based on
inaccurate perceptions of objective evidence (e.g., suc-
cess rate of psychiatric treatments) should be specifi-
cally targeted in the preclinical and clinical psychiatric
curricula.
The potential benefit of remediating such inaccurate
beliefs held by new medical students is highlighted by
their reported general motivations and interests re-
garding becoming physicians. These reported motiva-
tions and interests are fully consistent with careers in
psychiatry. For example, high prestige and high finan-
cial reward, two aspects that a career in psychiatry is
not as likely to provide as other specialties, were rated
least important by students as considerations for choos-
ing a specialty. In contrast, career features viewed by
freshman medical students to be most important in-
cluded the ability to have interpersonal interactions
with patients, to help their patients, to have an attrac-
tive lifestyle, and to be engaged in work that is highly
interesting and challenging. These are all features that
characterize a career in psychiatry.
CONCLUSIONS
Medical students enter medical school with dis-
tinctly negative attitudes toward a career in psychiatry
Freshman Year at Three Medical Schools
Rating for Psychiatry ANOVA
Mean SD F (df=3, 633) p
2.67 0.86 142.6 <0.001
2.62 1.08 57.3 <0.001
2.94 1.11 84.0 <0.001
2.53 1.23 37.6 <0.001
2.23 1.10 18.7 0.08
3.08 0.96 119.3 <0.001
2.99 1.04 116.5 <0.001
2.80 1.07 103.8 <0.001
3.19 0.99 127.3 <0.001
2.74 1.10 67.7 <0.001
2.65 1.05 40.8 <0.001
2.90 1.05 101.4 <0.001
2.97 1.22 50.7 <0.001
2.71 1.08 31.4 <0.001
1402 Am J Psychiatry 156:9, September 1999
PSYCHIATRY AS A PROSPECTIVE CAREER
compared with other specialties. Current attitudes
seem to represent a further erosion from already nega-
tive attitudes toward psychiatry that have been re-
corded among new medical students over the past two
decades, and they may account to some degree for the
declining numbers of medical students entering resi-
dencies in psychiatry. Some of these negative views are
subjective and less vulnerable to remediation, whereas
others appear to be more objectively refutable through
education. Such a process of correction may yield
greater interest in psychiatry as a career because stu-
dents value many features that characterize a career in
psychiatry. Whether their medical school experience
corrects, exacerbates, or leaves unaltered such views is
the focus of an ongoing longitudinal study.
REFERENCES
1. Sierles FS, Taylor MA: Decline of US medical student career
choice of psychiatry and what to do about it. Am J Psychiatry
1995; 152:14161426
2. National Residents Matching Program Match Results, 1988
1998. Washington, DC, National Residency Matching Pro-
gram
3. Neilsen AC III, Eaton JS Jr: Medical students attitudes about
psychiatry: implications for psychiatric recruitment. Arch Gen
Psychiatry 1981; 38:11441154
4. Fishman DB, Zimet CN: Specialty choice and beliefs about
specialties among freshman medical students. J Med Educ
1972; 47:524533
5. Friedman CTH, McGuire FL: A survey of a freshman medical
student class: will psychiatry recruit well into the 1980s? J
Psychiatr Education 1982; 5:115122
6. Yager J, LaMotte K, Nielson A III, Eaton JS Jr: Medical stu-
dents evaluation of psychiatry: a cross-country comparison.
Am J Psychiatry 1982; 139:10031009
7. Hsu TC, Feldt LS: The effect of limitations on the number of
criterion score values on the significant level of the F-test. Am
Educational Res J 1969; 6:515527
8. Weissman SH: American Association of Directors of Psychiat-
ric Residency Training Physician Workforce Initiative Report.
Farmington, Conn, AADPRT, Aug 11, 1994
9. Zimny GH, Sata LS: Influence on factors before and during
medical school on choice of psychiatry as a specialty. Am J
Psychiatry 1986; 143:7780; correction, 143:398
10. Flaherty JA, Blumberg P: Clinical psychology: a potential pool
for recruitment. J Med Educ 1984; 59:135141
11. 1978 US medical school graduates: career plans by racial/
ethnic identity. J Med Educ 1980; 55:721724
12. Eagle PF, Marcos LR: Factors in medical students choice of
psychiatry. Am J Psychiatry 1980; 137:423427
13. Bhurgra D: Attitudes towards mental Illness. Acta Psychiatr
Scand 1989; 80:112
14. Samuels L: Female psychotherapists as portrayed in film, fic-
tion and non-fiction. J Am Acad Psychoanal 1985; 13:367
378
15. Walter G: The stereotype of the mad psychiatrist. Aust NZ J
Psychiatry 1989; 23:547554
16. Walter G: The psychiatrist in American cartoons, 19411990.
Acta Psychiatr Scand 1992; 85:167172
17. National Advisory Mental Health Council: Health care reform
for Americans with severe mental illnesses. Am J Psychiatry
1993; 150:14471465
18. Market RJ: Change in specialty choice during medical school.
J Fam Pract 1983; 17:295300
19. Babbott D, Baldwin DC Jr, Jolly P, Williams DJ: The stability of
early specialty preferences among US medical school gradu-
ates in 1983. JAMA 1988; 259:19701975
20. Zeldo PB, Preston RC, Daugherty SR: The decision to enter a
medical specialty: timing and stability. Med Educ 1992; 26:
327332
21. Miller SI, Lenkoski LD, Wienstein D: Enduring attitude change
in medical students. J Psychiatr Education 1979; 3:171178
22. Linn BS, Zeppa R: Values and attitudes related to career pref-
erence and performance in the surgical clerkship. Arch Surg
1982; 117:12761280