We summarise findings from surveys of graduates from UK medical schools over 31 years. Serial surveys have been undertaken in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002. Questionnaires were sent to 33,151 doctors; 24,621 (74.3%) replied. Three years after qualification, 70.8% replied to a second survey; 5-years after qualification, seven cohorts were re-surveyed.

Trauma and orthopaedic surgery was the first choice career for 5.0% (men) and 1.0% (women) 1 year after qualification, and 5.2% (men) and 0.8% (women) at 5 years. Of those with T&O as first choice, 35% who chose it in year one, 56% in year three, and 84% in year five were working in it eventually. Experience as a student or junior, self-appraisal of skills, a particular teacher and enthusiasm for the specialty were the most important influences.

There has been an increase in the percentage of women choosing surgical careers. However, the much higher percentage of men who choose T&O surgery remains striking. The specialty needs to consider whether this matters. Women currently comprise about 60% of the medical school intake in the UK.

This study shows that doctors who ultimately pursued a surgical career made that choice by year 3 (equivalent to ST1) and between 84-92% had settled on the specialty by year 5 (ST3). Career progression for this historical cohort did not require an early commitment and a greater decisiveness may be anticipated in the more expectant system of Modernising Medical Careers.

It is unknown whether recent working time directives will influence career choice. This study defines T&O doctors to be highly motivated by work and not influenced by long working hours or competing domestic demands. This low priority places the specialty at the bottom of comparative tables. A change in work-life balance may directly impact future specialty recruitment.