A growing trend of females and dermatologists among top medical graduates in 30 years

Background: Career outcomes of top medical graduates (TMG) are seldom studied. The Tsungming Tu Foundation (TTF) has awarded the number one graduate from each medical school in Taiwan since 1981. We aimed to study whether TMG differ from all medical graduates (AMG) in gender, specialty, and geographic regions in the last 30 years. Methods: Overall, 322 TMG and 40,075 AMG were identified from 1981 to 2017 from TTF and Taiwan healthcare public data, respectively. Subjects were further grouped by their graduation year: 1981-1994, 1995-2001, 2002-2011, and after 2012. Ranges were based on implementation dates of new health care policies. Results: The percentages of female AMG increased from 10.9% before 1994 to 32.6% after 2012 (linear trend, P < 0.001). Similarly, the percentages of female TMG increased from 23.1% before 1994 to 42.4% after 2012 (linear trend, P = 0.003). In contrast to 2% of AMG, the percentages of TMG who became dermatologists increased from 11% to 20.5% (linear trend, P = 0.024). TMG favored dermatology, ophthalmology, and neurology, and avoided general surgery (P < 0.001). While still higher than AMG, the percentages of TMG working in medical centers dropped significantly from 58% during 1981-1994 to 33.3% during 1995-2001 (P = 0.035). This coincided with the launch of National Health Insurance in 1995. Finally, though more than half of TMG previously worked in Northern Taiwan, they have recently moved to Central Taiwan. Conclusions: The percentages of female AMG and TMG reached 32.6% and 42.4%, respectively, after 2012. TMG prefer to choose dermatology, ophthalmology, and neurology, but avoid general surgery. Changes in health policy, reimbursement policy, and medical education may be associated with AMG and TMG career choices.