I don't agree with the dichotomy (probably you don't either so not making a debating point!). I think the situation is complex. Factors impacting people's choice of medical career include

- parents being doctors

- altruism both pure and ego reward driven non-material factors e.g. being a healer

- status

- job security

- job offers flexibility (e.g. part time, back room and desk jobs as well as patient care)

- usually high pay, or at least above average

- interest in applied science

- interest in a rewarding job combining outcomes, status and high pay - i.e. hits multiple targets

- personality type

- aptitude profile

One should also consider the factors which discourage people such as long hours, stress, high entry gate, etc suggesting that the former factors must be strong enough to overwhelm these. I believe there is quite a big and accessible literature on this.

Dear Andrew,

Thanks for professional response.

So how do you think what factors (motivators) are predominant in a medical career, intrinsic or extrinsic?

Did you study those factors?

The motivation s behind people to seek medical education and hence become physicians is complex. These may also differ from population to another and from time to time. A number of studies can be found on the net on this issue. Last year we  did interview a sample of our medical students (90 students)  about some aspects of their medical studies including the motives for joining the medical school. Their answers were as follows: Professional prestige    (67%), Willingness of parents (65%) Financial rewards (8%), parents motives (21%).

In general I think the main motives are financial/social rewards and humanitarian  desire to serve people

Dear Omran,

The willingness of parents can lead a student to the medical faculty. But can it be a motivator for a serving physician to stay in his profession?

8% for financial rewards looks quite unconvincing against the background of good earnings of physicians.

Dear Anatoliy

I totally agree with you. Financial rewards is the hidden motivator. People may express it indirectly as prestigious. The willingness of parents in my view is behind a lot of troubles facing many students in medical education.

Thanks. No I have not studied the factors myself. Generally in career motivation I think it is difficult to weight individual factors as they interact in a dynamic way. An example is parents being doctors. This interacts in a complex way I suspect in terms of the children choosing to be doctors. They share the same biological attributes as the parent doctor, their early learning is heavily influenced by them etc. Being a doctor is normalised for them, and there may well be common motivators (personality type, aptitude profiles) that are all common. Thus the correlation between the parent's and child's choice of career goes beyond just social modelling and expectations.

Moreover, medical parents can act as role models or as enforcers to a disliked profession. This makes the motivation (to become a physician) completely different. And it is unlikely that the student (that was forced by parents) will ever be a good doctor.

Dear Anatoly.

 You ask why people become physicians and what motivates them. You continue and say that you are trying to understand whether our physicians are altruists or whether they are there to get money.

As the previous responses show, many factors, some personal (e.g., to be oriented to others' health and well-being; see the example of Doctors Without Borders), some situational (e.g., to grow up, say, in a family of doctors) may lead people to become physicians. Note that the Spanish thinker Ortega y Gasset once remarked that we are ourselves and our circumstances. This means that what we are in professional or other terms, depends on what type of persons we are (e.g., intrinsically or extrinsically motivated) and the physical and social environment  where we live (e.g., to be surrounded by a family of, say, doctors or teachers). See, for this respect, E.Deci's theory of self-determination and his distinction between intrinsic and extrinsic motivation.

Your question is an either/or question because you ask whether people become doctors because, say, of an altruistic and intrinsic motivation (e.g., to be committed to others' health and well-being) or an egocentric and extrinsic motivation (e.g, to have a socially prestigious profession). It may be the case that some doctors are so due to their sense of sensibility and concern with others' health and well-being (see the example of Doctors Without Borders), and some are doctors because they know that they are generally overpaid when compared to other professionals, teachers, for example. It may be the case that the majority of doctors are both intrinsically motivated and extrinsically motivated. Thus, the dichotomy you raise has not to be a dichotomous choice, as Andrews noticed.

All that said, I think that would be scientifically valuable to analyze people's reasons to become doctors according to Kohlberg's theory o moral stages.

Consider the following answer: "I want to become a doctor because I want to be a famous person among my patients and even among other professionals".This would be a stage-1 oriented reason. Think now of the following answer: "I want to become a doctor because I want to get money and doctors are in a good position to achieve this goal. This would be a stage-2 oriented response, reason or motivation.

Stages 1 and 2 are in Kohlberg's theory pre-conventional stages. Individuals at these stages are guided by egocentric needs and desires. They live, as it were, as a function of themselves and their egocentric and extrinsic motivations.

Consider now the following answer: "I want to become a doctor because I want to be recognized by my patients, their families, and even other professionals as a decent and reliable doctor".  This is would be a stage-3 oriented response or motivation.

Look now at the following answer: " I want to become a doctor because when a became a doctor I swore to be always preoccupied with others' health, and hence, I want to be honest with myself. As a doctor, I have rights but also duties." This would be a stage-4 oriented response or motivation to be a doctor.

Stages 3 and 4 in Kohlberg's theory are conventional stages. Individuals at these stages go beyond their egocentric motives and think of themselves as immersed in a community where they have legitimate rights but also duties to their community, namely to their patients.

Think now of this answer: "I want to be a doctor because my consultations or even my medical discoveries may bring about the greatest good for the greatest number of people." This would be a stage 5 or 6-oriented response. I say stage  5 or 6 because the late Kohlberg gave up his stage 6 in empirical terms, albeit he has maintained it as a moral ideal, telos, or end-state

Stages 5 and 6 in Kohlberg's theory are postconventional stages. Individuals at these stages are guided by universalizable and prescriptive principles (e.g., the golden rule, one's right to have, say, a decent  life).That is, principles we wanted to be followed by all people at all times and  places. Of course, this reminds us of  Kant's categorical imperative.

Needless to say, the more doctors (or other professionals) are morally developed, the more they are likely to be intrinsically motivated and  knowledgeable of their area of  specialization.

A caveat is in order at this point. You refer to physicians, say, as a whole .Note, however, that cardiologists and neurologists, just to mention  two examples, may  have  had  different reasons to be, respectively, cardiologists and neurologists,

I hope that  I have got your question and that this is of some help for you.

Best regards.

Dear Orlando,

Thank you for the extended response.

Being in the unique position of working with medical professionals in a hospital setting for ten years has given me some insight. Every year, the 7 wards I covered as an administrator, would have new FY1, FY2 and SHOs.Based on my observation and via discussions, I can clearly state that the novelty soon wears off and the altruism starts to show after the hard grind of being an FY1. I was able to observe how they react to their seniors, patients and colleagues, and only 5 out of 2520 are in the profession for extrinsic reasons. 2520 doctors I've met are altruists. I saw the passion, tears, joy, anger, frustration and disengagement in the rite of passage from medical school to consultants and I can truly say, if you don't have nerves of steel, patience and intellectually competent you cannot be a doctor.

Dear Sherida,

Thank you for an optimistic answer.

You described an almost perfect situation.

Hi Anatoliy,

Often, some parents, push their children to be a doctor or surgeon because of prestige. However, those who become doctors surgeons etc. are definitely not in the profession because I observed how they would often work beyond their hours to get matters sorted, often leaving well after their shifts has ended just to ensure their patients are safe. Many doctors and other clinicians cant even afford their own homes and yet they prefer to work where they are most needed and least paid instead of going to countries where they can be paid a king's ransom for the services. There is a standing joke between my daughter and myself. I would say to her:" Before I worked in the hospital, I wanted you to become a doctor. Now I see how difficult it is and how hard they have to work , become anything but a doctor because I love you too much and would rather you sane and healthy". :)

Good joke, Sherida :)

This profession is quite mysterious.

We are trying to find out how to reward (motivate) physicians to improve an efficiency of their work.

That's a difficult task as people are unique. There is a saying " You can please some of the people some of the time, some of the people all the time but you can never please everyone all of the time".

You are right, Sherida. Of course, we won't be able to satisfy everyone, but at least motives of the majority that is peculiar to this profession we could find.

Regardless, a doctor should always be in a position to help, often can relieve pain and occasionally can effectively practice to cure an illness. These are the three major attributes of professionalism in medicine. if a person is not prepared from the start and motivated from inside him/herself to act professionally and be practitioner (care giver) and scientific, he may face a lot of troubles. In addition effective communication with all partners including patients, relatives and staff is an additional (essential) element in the success of being a doctor.  

Dear Omran,

Of course, I agree with you. This is professionalism and if the doctor does not come to the rescue, he can be disqualified.

But what motivators are higher - internal or external?

Helping people, are they motivated by altruism or the fear of losing their jobs?