Pii: 0277-9536(83)90257-5

-This paper examines the relationship between choice of career and perception of the medical labor market, as well as the effects of social origin, type of medical school, and place of internship. The data are derived from a survey of interns which was conducted in Mexico during 19:/8, when a substantial proportion of physicians was unemployed or underemployed. Career preferences were operationalized in terms of type of activity (general practice or specialty}, site (ambulatory or hospital) and institution (public assistance, social security or private). Perceptions of the medical labor market were measured as an 'objective' feasibility perception and a 'subjective' opportunity assessment. Additionally, composite indices of career preferences and perceptions were constructed in order to take account of two integrated career patterns: dominant (or majority preference) vs alternative (or minority preference). Analysis of the data consistently revealed that perception of the medical labor market had a much stronger impact on preference for alternative than for dominant career patterns. Whereas social origin had "no effect on career preference, type of medical school and place of internship exhibited a statistical ineraction with career preference, suggesting that certain structural conditions of the medical school and the teaching hospitals lead to preference for alternative rather than dominant careers. The implications of the findings are discussed with regard to health manpower policy, to conceptions of rational career choice and to the professional status of medicine in Mexico. I. THE INTERNSHIP IN MEXICO For more than two decades, the internship has represented one of the central elements of medical education in Mexico. In contrast to the American situation, it is part of the formal curriculum of most medical schools. At the same time, the internship in Mexico is characterized by certain inconsistencies that render it a particularly interesting object of study. First, the amount of responsibility for direct patient care by interns varies considerably according to the needs of each hospital and the degree of control by the medical school. Typically, most medical schools exercise limited control over internship training. Second, while medical schools can set broad educational guidelines, the medical care institutions have substantial discretion in determining the clinical services through which interns rotate. Moreover, interns have their own organizations which have at times declared strikes mainly for pay increases. While these organizations are not formally recognized, they do engage in collective bargaining. However, the agreements reached through such negotiations are ratified by the universities and the health care institutions, exclusive of the interns. Thus tension has generated from the dual role of interns as students in medical schools and as workers in health care institutions [1]. A broader issue that might explain the problem addressed in this paper pertains to the conditions of the medical labor market that interns have to face upon graduation. Starting in the early 1970s, the labor market for physicians has been characterized by a marked disequilibrium. Total studdnt enrollment increased from 20.127 in 1967 to 41,675 in 1971 [2] and to 80,396 in 1977 [3]. However, due to the slump experienced by the Mexican economy in the 1970s, the expansion in the production of physicians was not accompanied by a corresponding growth in the health care sector [4]. As a result, unemployment began to appear among medical graduates. For example, there were 8000 such graduates in 1978 but only 1800 positions for residency, and it was estimated that the entire health care system, both public and private, could absorb no more than 3000 new physicians per year [5]. Hence, about 40~o of the graduates had to face unemployment or underemployment. Ironically, this occurred while about one-third of the Mexican population was officially estimated not to have access to medical services [6]. Although the increased exportation of oil after 1979 improved the economic situation, leading to an expansion of the health sector, the momentum developed during the previous decade has made it unlikely that the current disequilibrium in the medical labor market will be corrected in the near future. In fact, such disequilibrium could become even more severe under the renewed economic weakness brought about by the world-wide fall in oil prices. Faced with reduced revenues and a growing debt, the Mexican government has already cut public expenditures, in a move that could further deteriorate the ability of the health care institutions to absorb the increased supply of physicians.