Structural factors as determinants of career patterns in medicine.

This study was concerned with the role of structural factors in influencing medical career outcomes. These factors were viewed as an interrelated network of institutions, linked in particular patterns, leading to alternative career outcomes. A conceptual model was developed to represent the expected, predominant routes to different career outcomes. Analysis of data gleaned from the Association of American Medical College's Longitudinal Study revealed neither the expected patterns nor distinctive, alternative patterns. Thus, the notion that medical education is a rigidly structured system, consisting of a few, relatively fixed patterns leading to different career outcomes, was not supported. However, further analysis indicated evidence of stratification among structural factors in the medical education system which serves to influence access to career pathways.