Endocrinology and nutrition: Evolution of the choice of specialty in the last years

The practice of Endocrinology and Nutrition in Spain requires a Medical Degree as well as specific training in this specialty.¹ To have access to such specialized training the student must first pass a state examination organized on an annual basis by the Spanish Ministry of Health (Ministerio de Sanidad, Servicios Sociales e Igualdad [MSSSI]), called the MIR (Médico Interno Residente or Resident in Training exam). Following the examination, the candidates receive a score and order number allowing them to choose a specialized training position.² The higher the score, the better the assigned order number, i.e., a candidate with the highest score becomes the first to choose his or her specialized training position. The positions are offered and assigned by the MSSSI, and the data are made public. Endocrinology and Nutrition is one of the specialties offered each year. This Letter analyzes the offers of and the demand for the specialty in recent years and provides a map of the Spanish Autonomous Communities and centers requested, with the best MIR examination scores. The study is based on the official specialty position assignment data of the MSSSI covering the period from the MIR examination of 2006 to that of 2015, which corresponds to the assignment of positions that took place in 2016. The analysis presents the mean, maximum and minimum values, as well as the median and percentiles 25 and 75 of the order number. Due to the asymmetrical distribution of the order numbers, medians were used for purposes of comparison.

In the period 2006–2015 the number of positions offered in Endocrinology and Nutrition ranged from a minimum of 56 in the year 2006 to a maximum of 76 in 2012. The number of positions offered increased gradually up until 2012. A slight decrease was recorded after that year, in parallel to the decrease in total residency positions, with a total of 72 positions offered in 2015.

During the period 2006–2015 the minimum order number with which the specialty of Endocrinology and Nutrition was chosen was 3, with a maximum of 4143—the latter representing the last chosen position in the period under consideration. The median order number for choosing the specialty in that period was 1394, with a mean of 1503.7. On limiting the analysis to the final 5-year period, the median was 1624.5, and the mean 1696.1. The annual evolution of the median experienced slight variations, influenced in part by the number of positions in Endocrinology and Nutrition offered each year. The maximum or highest median was recorded in 2012, with a value of 1915, and that same year a total of 76 positions in Endocrinology and Nutrition were offered (the largest number of positions offered). By contrast, the lowest median corresponded to the year 2006, with a value of 792.5, and with a total of 56 positions offered (the lowest number during the period 2006–2015).

With regard to the choice of Endocrinology and Nutrition with respect to other medical specialties, the pooled data corresponding to the period 2011–2015 showed Endocrinology and Nutrition to be in 11th position in the list of specialties. A specific analysis of the year 2015 showed Endocrinology and Nutrition to rank 12th out of the 44 specialties offered.

On analyzing the situation according to the Autonomous Communities, Madrid offered the largest number of positions in Endocrinology and Nutrition in the period 2011–2015 (n = 95; 25.8% of the total). It was followed by Catalonia (n = 60; 16.3%) and Andalusia (n = 50; 13.6%). The Communities offering the fewest positions were Asturias, Cantabria and Extremadura, with 5 positions each.

On analyzing the ranking according to the Autonomous Communities for the period 2011–2015, the Basque Country showed the lowest median order number (839), followed by Asturias (864) and Navarre (887). Table 1 shows the Autonomous Communities distributed from best to worst median order number. Likewise, the table shows the hospital in each Community with the lowest order number for that period. In Asturias, Cantabria and Extremadura the Community and hospital data coincide, since these Communities had a single center offering Endocrinology and Nutrition.

Table 1.

Ranking of the Autonomous Communities distributed according to median order number, with the data corresponding to the period 2011–2015. The hospital in each Community with the lowest order number for that period is shown.

Ranking according to Autonomous Communities and hospitals in each Community in the period 2011–2015
	No.	Mean	Minimum	Maximum	p25	Median	p75
Basque Country	10	1071.7	527	2318	706	839	1282
H. U. Cruces	5	965.4	527	1672	545	801	1282
Asturias	5	1097.6	317	2737	509	864	1061
H. U. Central de Asturias	5	1097.6	317	2737	509	864	1061
Navarre	10	1321.8	23	4143	559	887	2095
Clínica Universidad de Navarra	6	1363.7	205	4143	559	887	1501
Valencian Community	29	1081.1	14	2743	563	987	1467
H. U. i Politècnic la Fe	5	230.4	14	563	96	160	319
Madrid	95	1309.8	55	3119	743	1248	1877
H. U. Puerta de Hierro	10	661.4	132	1321	298	515.5	1258
Catalonia	60	1391.3	60	3923	470.5	1289.5	2197
H. Clínic de Barcelona	10	709.5	60	1669	157	244	1472
Aragon	10	1597.7	267	3092	1149	1539.5	2078
H. U. Miguel Servet	5	1091.2	267	1757	706	1149	1577
Murcia	11	1784.3	532	3169	867	1756	2577
H. Clínico. U. Virgen de la Arrixaca	4	843.5	532	1313	597	764.5	1090
Cantabria	5	1759.4	884	2289	1421	1946	2257
H. U. Marqués de Valdecilla	5	1759.4	884	2289	1421	1946	2257
Andalusia	50	2071.9	447	3778	1431	2135.5	2681
H. Virgen de la Victoria	5	1213	447	2603	511	698	1806
Galicia	19	2345.9	632	3689	1362	2444	3374
C. H. U. A Coruña	5	1631.2	632	2603	1208	1362	2351
Canary Islands	21	2419.2	525	3861	1796	2481	3237
H. U. Insular de Gran Canaria	6	2036.2	525	3532	681	2000	3479
Castilla-La Mancha	8	2493.8	108	3577	2314.5	2748.5	3069.5
C. H. U. de Albacete	3	1844	108	2886	108	2538	2886
Balearic Islands	10	2706.4	1595	3658	2076	2788.5	3182
H. U. Son Espases	5	2367	1595	3397	1899	2076	2868
Castile and León	20	2554	232	3848	1634	2904	3261.5
H. C. U. de Valladolid	2	1176	232	2120	232	1176	2120
Extremadura	5	2800.6	1285	3629	1844	3618	3627
C. H. U. de Badajoz	5	2800.6	1285	3629	1844	3618	3627

C., clinic; C. H. U., university hospital complex; H., hospital; No., total number of positions offered during the period; p25, percentile 25; p75, percentile 75; U., university.

The ranking of the 10 hospitals in Spain in terms of choice according to the pooled data from 2011 was headed by the university hospitals Politècnic la Fe, Clínic de Barcelona and Puerta de Hierro. Their median order numbers were 160, 244 y 515.5, respectively. These three hospitals were followed by Mar-Parc de Salut Mar, Santa Creu i Sant Pau, Virgen de la Victoria, Ramón y Cajal, Virgen de la Arrixaca, Clínico San Carlos and Cruces—the latter hospital having a median order number of 801 in this period.

Endocrinology and Nutrition is an attractive option and a favorite among the specialties on offer. The median choice status of the specialty has varied little over the years, and the existing variation is influenced in part by variations in the number of positions offered. The ranking according to the Autonomous Communities and centers shows important variations in the median order number, suggesting that certain predilections are relatively constant. The data presented correspond to an objective analysis of the choice of Endocrinology and Nutrition based on the official information of the MSSSI. Our study does not propose to provide an analysis of the care or teaching quality of the different resident training centers as this aspect has been addressed in other studies.^3,4 The choice of medical specialty and resident training center is influenced by a number of personal factors such as perception of the specialty, prestige, geographical preferences, etc.,^5–7 that have not been evaluated in this study. Nevertheless, this simple analysis presents data regarding the general level of interest in the specialty, and depicts the geographical and resident training center preferences of future residents.