Choice of the specialty of diagnostic radiology by results of the competitive examination to assign residency positions from 2006 to 2015

Abstract

Objective

To analyze the profile of residency candidates choosing the specialty of diagnostic radiology in function of variables related to the positions available in different years.

Materials and methods

We compiled the data published on the Spanish Ministry of Health's website during the acts celebrated to allow residency candidates to choose positions based on the results of the competitive examinations held from 2006 to 2015, comparing the specialty of diagnostic radiology with the other specialties available in terms of positions available, net questions, sex, nationality, and order of choice of the position.

Results

The specialty of diagnostic radiology occupied the 16th position in the ranking of specialties according to the median number of order in the choice for each of the positions offered in the years studied. The first diagnostic radiology residency position was usually assigned after 75 candidates had chosen other specialties, and the last position was usually assigned after 3700–4100 candidates had chosen their positions. During the period studied, of those who chose diagnostic radiology 58% were women and 76% were Spanish nationality. Candidates preferred hospitals in the Autonomous Community of Madrid, and the hospital chosen with the lowest median position (highest score on the competitive examination) was the Hospital Clínic de Barcelona.

Conclusions

Diagnostic radiology is chosen by candidates with good positioning in the ranking according to official examination results, is less likely than other specialties to be chosen by women, and is chosen mostly by Spanish physicians. Candidates prefer large hospitals in provincial capitals.

Resumen

Objetivo

Analizar el perfil del opositor que ha escogido la especialidad de radiodiagnóstico, analizando variables relacionadas con las plazas convocadas a lo largo de la historia.

Material y métodos

Se recogen los datos publicados por el Ministerio de Sanidad español en su página web durante los actos de elección de plaza en el examen MIR desde el año 2006 hasta 2015, comparando la especialidad de radiodiagnóstico con el resto de las ofertadas en términos de plaza, preguntas netas, sexo, nacionalidad y lugar de elección de la plaza.

Resultados

La especialidad de radiodiagnóstico ocupa la posición número 16 en el ranking de especialidades ordenadas según la mediana de número de orden con la que se escogió cada una de sus plazas desde el año 2006 hasta 2015. La primera plaza se suele escoger por debajo del número de orden 75 y la elección de la especialidad se suele terminar entre los números de orden 3.700 y 4.100. Durante el periodo estudiado, un 58% de los electores de radiodiagnóstico fueron mujeres y un 76%, españoles. Los opositores prefieren los hospitales de la comunidad de Madrid, y el hospital elegido con la mediana más baja (mejor número de orden) es el Hospital Clínic de Barcelona.

Conclusiones

Radiodiagnóstico se escoge en el MIR con buenos números de orden, con menor tendencia a ser elegida por mujeres que otras especialidades y escogida en su mayoría por médicos españoles. Se prefieren hospitales grandes en capitales de provincia.

Introduction

In Spain, in order to be able to practice medicine, the college degree of Bachelor in Medicine and Surgery, Bachelor in Medical Science or degree in Medicine is needed. Since 1984 and as the only available way to be able to have access to specialized medical training it is mandatory to pass a nationwide access exam that the Ministry of Health, Social Services, and Equality announces every year. This exam is known as the MIR (Medical Residency Exam).¹

Since 2009, the exam consists of 225 multiple choice test-like questions together with 10 reserve questions. Theoretically, the maximum number of net questions one candidate can take is 225, yet noone has ever been able to take more than 200 net questions. Net questions are those questions answered correctly in the exam minus one third of the amount of questions failed.^1–3 The grade obtained in the exam (90 per cent of the final grade), added to the assessment of the scale or academic record (10 per cent of the final grade) is used to classify all candidates from first to last based on their respective scores. A higher total score equals a lower position in the classification, so candidate #1 will be the candidate with the highest final grade of all who will have earned the right to be the first one to choose his/her medical specialty among the different medical specialties available in the existing accredited academic institutions across the country.

Diagnostic radiology is one of these medical specialties since the MIR exam became a reality for choosing medical specialties back in the 1980s. The official denomination of this specialty – diagnostic radiology dates back to 1984 and is defined as that medical specialty based on imaging diagnoses aimed at achieving diagnostic impressions from macroscopic images of the inside of the body obtained using minimally or absolutely non invasive procedures that may include the use of different kinds of ionizing radiations and other types of power sources. Also, radiologists are responsible for what is known as the “method as the basis for the technique”’ that includes two different moments: choosing the most appropriate procedure (radiological technique) and acknowledging, analysing and interpreting the radiological signs.^1,2

The main goal of this paper is to study what the profile of these candidates who choose the specialty of diagnostic radiology is by analysing the variables associated with the positions made available by the government from the very beginning, and the variables associated with the position within the MIR classification list that, in general, allowed the candidates to choose this specialty, based on sex, origin, hospital, and geographical region. The secondary goal of this paper is to compare the tendencies in the candidates’ profile with other published papers in other settings of similar profile,^4–13 and make a correlation between them and surveys from the Spanish Ministry on specialists in medical training.^14,15

Materials and methods

One retrospective descriptive analysis was designed of the numbers of order, exam grade, age, sex, nationality of the candidaes and destination hospitals with the specialty of diagnostic radiology in the access test to the MIR medical residency exam announced publicly every year by the Spanish Ministries of Health and Education, from 2006 until present.

The denomination of the exam follows the nomenclature by the Spanish Ministry of Health including the year the exam was publicly announced - usually one year before taking the exam (the MIR medical residency exam 2015 took place in January, 2016). Data have been collected from the specialty choosing events published by the Ministry of Health in its official website after every annual public announcement.¹ The “quota for foreign physicians” is the amount of total positions that can be assigned to non-EU physicians who are not sons or spouses of EU citizens, or who do not have a permit license, or are not EU residents.

Since some of the institutions that used to offer this specialty have changed along the study period–the names with which they appear within the specialty choosing lists published by the ministry, there have been times that certain institutions that were offered with a different denomination have been grouped under one single name, and this is the way they are shown both in the tables and the document herein.

The value of net questions needed to be able to choose diagnostic radiology, the average, maximum and minimum values, mean value, and percentiles 25 and 75 of the candidates’ order of choosing have been assessed by comparing the specialty of diagnostic radiology with the remaining specialties. This is an analysis of all positions segemented by institution and autonomous community. Both the demographical data and origin of the candidates have been collected too. The estimation of percentiles has been graded by weighted percentages and influenced by data distribution.

Results

The average of positions offered from 2006 though 2015, both inclusive, was 217.1; the year with the largest public offer was 2009 with 229 positions and the year with the smallest public offer was 2014 with 207 positions. The percentage of positions with respect to the total was 3.36 per cent and ranged between 3.25 per cent and 3.46 per cent depending on the year (Table 1, Fig. 1). In Spain, the specialty of diagnostic radiology ranks #8 in the list of medical specialities with the largest number of positions offered, with a total of 2171 in the 10 years studied (Table 2). The specialties that have ran out of positions during the specialty choosing events during the last 10 years have been plastic surgery, that was chosen with the lowest average number of order for choosing, 332, followed by dermatology, cardiology, and neurosurgery. Diagnostic radiology ranks #16 (of a total of 47 specialties, including the specialties offered by professional schools) with an average number of order for choosing of 1.965. This standing is maintained when the specialties are arranged according to percentiles 25, 50, or 75 of the numbers of order necessary to choose them (Table 2), or when the analysis is conducted only with the last MIR exam from 2015.

Table 1.

General data for the specialty of diagnostic radiology when choosing specialty from 2006 through 2015.

Public announcement	Number of students who took the MIR exam	Obtained number of order	Total positions offered	Positions for diagnostic radiology	Positions percentage for diagnostic radiology
MIR 2006	8.148	8.148	6.048	209	3.46
MIR 2007	8.897	8.898	6.517	217	3.33
MIR 2008	9.471	9.428	6.797	221	3.25
MIR 2009	11.438	11.407	6.944	229	3.30
MIR 2010	11.623	11.554	6.874	228	3.32
MIR 2011	11.906	11.868	6.704	225	3.36
MIR 2012	11.771	9.182	6.388	218	3.41
MIR 2013	10.241	7.360	6.145	208	3.38
MIR 2014	10.801	8.554	6.079	207	3.41
MIR 2015	11.227	9.288	6.097	209	3.43
Total	105.523	95.687	64.593	2.171	3.36

Figure 1.

Total of positions offered: progression of the public offer of diagnostic radiology positions in the MIR exam with respect to the total of positions offered. Notice data truncation in the axis of ordinates between 195 and 235 in diagnostic radiology positions (left) and between 5600 and 7200 in the total of positions offered (right) in order to see the correlation between the variation of all the positions offered and the total of positions offered in diagnostic radiology only.

Table 2.

Comparison among different specialties from 2006 through 2015.

Especialidad	#	Min.	p25	Average	p75	Max.	Median	Number of positions
Plastic and reconstructive surgery	1	3	114	255	499	1174	332	330
Dermatology	2	1	176	348	562	1596	401	740
Cardiology	3	1	210	484	951	2638	636	1488
Neurosurgery	4	2	468	1095	1815	3283	1174	389
Neurology	5	1	517	1138	2041	4120	1331	1168
Pediatric surgery	6	29	504	1143	1882	3076	1247	204
Cardiovascular surgery	7	8	690	1325	2120	3727	1424	240
Oral and maxillofacial surgery	8	8	815	1370	2062	3296	1463	292
Endocrinology and nutrition	9	3	683	1390	2166	3923	1499	694
Pediatrics	10	2	770	1398	2114	3818	1468	3941
Ophthalmology	11	3	855	1447	2123	3601	1517	1598
Digestive system	12	1	851	1573	2288	3920	1603	1360
Obstetrics and gynecology	13	4	1027	1748	2602	3797	1800	2496
Orthopedic and trauma surgery	14	2	1078	1888	2661	3825	1871	2140
Urology	15	4	1040	1912	2693	3823	1866	898
Diagnostic radiology	16	6	1164	1965	2781	4227	1975	2171
General/Digestive system surgery	17	1	1252	2053	2831	3823	2013	1805
Angiology and vascular surgery	18	42	1235	2089	2914	3879	2036	351
Otorhinolaryngology	19	27	1339	2150	2872	3901	2099	775
Medical oncology	20	2	1208	2236	3347	5006	2270	1012
Anesthesiology	21	5	1505	2375	3071	4226	2260	3185
Thoracic surgery	22	32	2329	2796	3171	3837	2602	180
Rheumatology	23	12	2025	2949	3662	4913	2771	490
Internal Medicine	24	3	1632	3106	4124	5903	2870	3088
Psychiatry	25	1	2110	3292	4184	9035	3091	2296
Hematology and hemotherapy	26	1	2260	3432	4101	5822	3106	1149
Pneumology	27	58	2894	3586	4017	8149	3379	1046
Nephrology	28	16	2747	3639	4170	5330	3360	895
Intensive Medicine	29	7	2756	3677	4104	5441	3317	1535
Radiation oncology	30	308	3660	4152	4607	5826	4059	494
Physical medicine and rehabilitation	31	53	3767	4420	4967	7161	4292	917
Allergology	32	1102	4043	4680	5196	7217	4593	505
Pathological anatomy	33	18	3741	4798	5664	8357	4543	864
Nuclear medicine	34	1676	4370	5100	5541	7097	4953	378
Geriatrics	35	117	4453	5241	5724	8111	5038	567
Immunology	36	1335	4418	5281	6096	8962	5238	108
Neurophysiology	37	39	4369	5319	5963	7754	5045	398
Microbiology and parasitology	38	50	5225	6041	6740	10343	5882	337
Preventive medicine and public health	39	30	4658	6089	7177	11315	5761	729
Clinical pharmacology	40	727	5266	6155	6915	9114	6041	186
Clinical laboratory	41	24	5091	6190	7116	10457	6067	242
Family and community medicine	42	40	5030	6196	7451	11604	6286	17342
Legal and forensic medicine	43	25	5242	6277	7379	9612	6216	206
Biochemistry	44	1139	5798	6720	7701	11533	6802	117
Labor medicine	45	1149	5886	6845	7789	11472	6875	880
Medical hydrology	46	3482	6570	7522	8337	10972	7543	76
Physical education and sports medicine	47	582	6724	7865	9242	11862	7985	683

The number of positions, the minimum and maximum numbers of positions, percentiles 25, 50, and 75, and average numbers are shown in this table. Specialties have been arranged based on the orden number average required to choose among such specialties from 2006 through 2015.

Between the years 2006 and 2015, the lowest number of order with which the specialty of diagnostic radiology was chosen was 6 in the year 2010, and the highest number of order was 4227 in the year 2012. The year with the lowest average number of order (1772) for choosing the specialty of diagnostic radiology was 2006, and the year with the highest average number of order (2130) was 2012. (Table 3).

Table 3.

Analysis of numbers of order needed to be able to choose the specialty of diagnostic radiology from 2006 through 2015.

	First	p75	p50	p25	Last	Average	SD	Range
MIR 2006	21	1106	1799	2405	3447	1772	871	3426
MIR 2007	73	1016	1781	2456	3851	1794	942	3778
MIR 2008	52	1261	1936	2712	4018	1998	988	3966
MIR 2009	164	1066	2131	2949	3964	2036	1039	3800
MIR 2010	6	1262	1963	2892	3715	2002	981	3709
MIR 2011	73	1114	1949	2760	3970	1954	1010	3897
MIR 2012	42	1280	2162	2994	4227	2130	1037	4185
MIR 2013	8	1058	1925	2742	4066	1943	1033	4058
MIR 2014	28	1296	2048	2950	3802	2088	1012	3774
MIR 2015	25	1234	1988	2831	3943	2036	1044	3918
Total	492	11693	19682	27691	39003	19753	9957	38511

SD: standard deviation.

With respect to net questions, right questions answered minus one third of the questions failed, and using as a reference a 10 year statistics average, the specialty of diagnostic radiology may be chosen starting at 179.3 nets questions all the way through 105.7 net questions. The year 2014 was the year when this specialty was chosen with the highest score of net questions, 187.67 and the year 2008 when the last position in this specialty was chosen with the lowest score of net questions, 85.67 (Table 4).

Table 4.

Analysis of the amount of net questions, and correct questions minus one third of the amount of questions failed with which the specialty of diagnostic radiology was chosen from 2006 through 2015.

	First	p75	p50	p25	Last	Average	SD	Range
MIR 2006	18000	14200	13000	12133	9233	13205	1568	8767
MIR 2007	17533	14233	13267	12133	9233	13278	1545	8300
MIR 2008	17467	14467	13133	12267	8567	13266	1625	8900
MIR 2009	16933	14000	12567	11533	8967	12708	1609	7966
MIR 2010	18133	13517	12567	11692	10400	12743	1393	7733
MIR 2011	17567	15067	13933	13000	11467	14090	1324	6100
MIR 2012	18167	15167	14184	13333	11700	14305	1274	6467
MIR 2013	18667	14867	13750	12700	10867	13875	1456	7800
MIR 2014	18767	15150	14400	13617	12600	14469	1150	6167
MIR 2015	18100	15333	14667	13867	12700	14685	1093	5400
Total	179334	146001	135468	126275	105734	136624	14037	736

When it comes to analysing the positions chosen in diagnostic radiology according to sex and origin of the candidates, during the last ten (10) years, 58.22 per cent of the candidates have been women and 76.42 per cent of the candidates have been Spanish physicians. The year with the largest amount of women was 2012 with 65 per cent, and the year with the largest amount of Spanish physicians was 2006 with 92 per cent. The year 2009 was the year with the lowest percentage of women (52 per cent) and 2011 was the year with the lowest amount of Spanish physicians (65 per cent) (Table 5). The specialty of diagnostic radiology ranks #33 in the ranking of specialties arranged by highest percentage of women, and ranks #21 in the ranking of specialties arranged by highest percentage of foreign physicians (Tables 6 and 7).

Table 5.

Analysis of candidates who chose the specialty of diagnostic radiology based on sex and nationality (Spanish or foreign physicians).

	Women	Men	Spaniards	Foreigners	Total
MIR 2006	121 (58 per cent)	88	193 (92 per cent)	16	209
MIR 2007	134 (62 per cent)	83	180 (83 per cent)	37	217
MIR 2008	131 (59 per cent)	90	175 (79 per cent)	46	221
MIR 2009	118 (52 per cent)	111	161 (70 per cent)	68	229
MIR 2010	136 (60 per cent)	92	162 (71 per cent)	66	228
MIR 2011	139 (62 per cent)	86	147 (65 per cent)	78	225
MIR 2012	142 (65 per cent)	76	151 (69 per cent)	67	218
MIR 2013	113 (54 per cent)	95	161 (77 per cent)	47	208
MIR 2014	111 (54 per cent)	96	154 (74 per cent)	53	207
MIR 2015	119 (57 per cent)	90	175 (84 per cent)	34	209
Total	1264 (58 per cent)	907	1659 (76 per cent)	512	2171

Table 6.

Classification of medical specialties arranged according the percentage of candidates who chose them in the 10 years of study. Diagnostic radiology ranks #33 with an average 58.26 per cent of women among the candidates.

	Specialties	Years of training	Women	Women/total percentage	Men	Men/total percentage	Total
1	Obstetrics and gynecology	4	2174	85.62 per cent	365	14.38 per cent	2539
2	Pediatrics and specific areas	4	3387	85.42 per cent	578	14.58 per cent	3965
3	Allergology	4	397	77.09 per cent	118	22.91 per cent	515
4	Endocrinology and nutrition	4	536	76.14 per cent	168	23.86 per cent	704
5	Hematology and hemotherapy	4	850	73.21 per cent	311	26.79 per cent	1161
6	Rheumatology	4	356	72.36 per cent	136	27.64 per cent	492
7	Pediatric surgery	5	147	71.71 per cent	58	28.29 per cent	205
8	Family and community medicine	4	12033	69.14 per cent	5372	30.86 per cent	17405
9	Psychiatry	4	1595	68.96 per cent	718	31.04 per cent	2313
10	Physical medicine and rehabilitation	4	630	68.40 per cent	291	31.60 per cent	921
11	Pneumology	4	711	67.33 per cent	345	32.67 per cent	1056
12	Medical-surgical dermatology and venereology	4	507	66.89 per cent	251	33.11 per cent	758
13	Medical oncology	5	697	66.70 per cent	348	33.30 per cent	1045
14	Radiation oncology	4	336	65.88 per cent	174	34.12 per cent	510
15	Digestive system	4	904	65.70 per cent	472	34.30 per cent	1376
16	Microbiology and parasitology	4	224	65.31 per cent	119	34.69 per cent	343
17	Clinical neurophysiology	4	265	65.27 per cent	141	34.73 per cent	406
18	Internal Medicine	5	2024	65.00 per cent	1090	35.00 per cent	3114
19	Nephrology	4	585	64.71 per cent	319	35.29 per cent	904
20	Geriatrics	4	368	64.67 per cent	201	35.33 per cent	569
21	Clinical laboratory	4	164	64.31 per cent	91	35.69 per cent	255
22	Pathologica anatomy	4	554	63.31 per cent	321	36.69 per cent	875
23	Preventive medicine and public health	4	465	63.18 per cent	271	36.82 per cent	736
24	Intensive Medicine	5	972	62.95 per cent	572	37.05 per cent	1544
25	Neurology	4	745	62.82 per cent	441	37.18 per cent	1186
26	Labor medicine	4	555	62.78 per cent	329	37.22 per cent	884
27	Anesthesiology and resuscitation	4	1997	61.81 per cent	1234	38.19 per cent	3231
28	Ophthalmology	4	1002	60.54 per cent	653	39.46 per cent	1655
29	General/Digestive system surgery	5	1094	60.11 per cent	726	39.89 per cent	1820
30	Immunology	4	65	59.63 per cent	44	40.37 per cent	109
31	Otorhinolaryngology	4	467	59.26 per cent	321	40.74 per cent	788
32	Clinical pharmacology	4	111	58.42 per cent	79	41.58 per cent	190
33	Diagnostic radiology	4	1264	58.22 per cent	907	41.78 per cent	2171
34	Clinical biochemistry	4	67	57.26 per cent	50	42.74 per cent	117
35	Nuclear Medicine	4	218	55.33 per cent	176	44.67 per cent	394
36	Angiology and vascular surgery	5	191	54.26 per cent	161	45.74 per cent	352
37	Cardiology	5	764	50.66 per cent	744	49.34 per cent	1508
38	Thoracic surgery	5	89	49.44 per cent	91	50.56 per cent	180
39	Oral and maxillofacial surgery	5	142	47.81 per cent	155	52.19 per cent	297
40	Urology	5	427	46.77 per cent	486	53.23 per cent	913
41	Cardiovascular surgery	5	100	41.67 per cent	140	58.33 per cent	240
42	Orthopedic and trauma surgery	5	874	40.20 per cent	1300	59.80 per cent	2174
43	Neurosurgery	5	159	40.15 per cent	237	59.85 per cent	396
44	Plastic and reconstructive surgery	5	127	37.24 per cent	214	62.76 per cent	341
	Total		41339	65.98 per cent	21318	34.02 per cent	62657

Table 7.

Absolute and relative values of the positions adjudicated to the different medical specialties on grouds of public demand arranged from the lowest to the highest percentage of foreign physicians among the candidates (from the public announcement made in 2006 until the public announcement made in 2015).

	Specialties	Years of training	Foreigners	Foreigners/total percentage	Spaniards	Spaniards/total percentage	Total
1	Pediatrics and specific areas	4	218	5.50 per cent	3733	94.15 per cent	3965
2	Obstetrics and gynecology	4	225	8.86 per cent	2298	90.51 per cent	2539
3	Neurology	4	115	9.70 per cent	1061	89.46 per cent	1186
4	Psychiatry	4	235	10.16 per cent	2065	89.28 per cent	2313
5	Medical-surgical dermatology and venereology	4	88	11.61 per cent	668	88.13 per cent	758
6	Oral and maxillofacial surgery	5	38	12.79 per cent	259	87.21 per cent	297
7	Orthopedic and trauma surgery	5	274	12.60 per cent	1889	86.89 per cent	2174
8	Internal Medicine	5	384	12.33 per cent	2698	86.64 per cent	3114
9	Cardiology	5	202	13.40 per cent	1298	86.07 per cent	1508
10	General/Digestive system surgery	5	282	15.49 per cent	1523	83.68 per cent	1820
11	Medical oncology	5	175	16.75 per cent	865	82.78 per cent	1045
12	Pediatrics surgery	5	33	16.10 per cent	169	82.44 per cent	205
13	Anesthesiology and resuscitation	4	560	17.33 per cent	2648	81.96 per cent	3231
14	Digestive system	4	247	17.95 per cent	1120	81.40 per cent	1376
15	Plastic and reconstructive surgery	5	64	18.77 per cent	273	80.06 per cent	341
16	Endocrinology and nutrition	4	139	19.74 per cent	562	79.83 per cent	704
17	Intensive Medicine	5	299	19.37 per cent	1226	79.40 per cent	1544
18	Urology	5	185	20.26 per cent	717	78.53 per cent	913
19	Physical medicine and rehabilitation	4	196	21.28 per cent	714	77.52 per cent	921
20	Angiology and vascular surgery	5	82	23.30 per cent	269	76.42 per cent	352
21	Diagnostic radiology	4	496	22.85 per cent	1659	76.42 per cent	2171
22	Hematology and hemotherapy	4	264	22.74 per cent	885	76.23 per cent	1161
23	Neurosurgery	5	92	23.23 per cent	301	76.01 per cent	396
24	Ophthalmology	4	380	22.96 per cent	1253	75.71 per cent	1655
25	Preventive medicine and public health	4	164	22.28 per cent	555	75.41 per cent	736
26	Rheumatology	4	132	26.83 per cent	354	71.95 per cent	492
27	Family and community medicine	4	4574	26.28 per cent	12470	71.65 per cent	17405
28	Clinical laboratory	4	64	25.10 per cent	180	70.59 per cent	255
29	Pneumology	4	294	27.84 per cent	744	70.45 per cent	1056
30	Radiation oncology	4	150	29.41 per cent	353	69.22 per cent	510
31	Pathological anatomy	4	271	30.97 per cent	581	66.40 per cent	875
32	Cardiovascular surgery	5	81	33.75 per cent	154	64.17 per cent	240
33	Thoracic surgery	5	60	33.33 per cent	115	63.89 per cent	180
34	Clinical neurophysiology	4	131	32.27 per cent	258	63.55 per cent	406
35	Alergology	4	182	35.34 per cent	320	62.14 per cent	515
36	Otorhinolaryngology	4	290	36.80 per cent	488	61.93 per cent	788
37	Nuclear Medicine	4	149	37.82 per cent	236	59.90 per cent	394
38	Nephrology	4	351	38.83 per cent	534	59.07 per cent	904
39	Microbiology and parasitology	4	119	34.69 per cent	201	58.60 per cent	343
40	Clinical biochemistry	4	42	35.90 per cent	66	56.41 per cent	117
41	Labor Medicine	4	376	42.53 per cent	473	53.51 per cent	884
42	Geriatrics	4	255	44.82 per cent	291	51.14 per cent	569
43	Clinical pharmacology	4	88	46.32 per cent	89	46.84 per cent	190
44	Immunology	4	55	50.46 per cent	45	41.28 per cent	109
	Total	13101	20.91 per cent	48660	77.66 per cent	62657

The autonomous community that has offered the largest amount of positions for the specialty of diagnostic radiology from 2006 through 2015 has been Madrid with 432 (20 per cent), followed by Andalucía with 330 (15 per cent), and Catalonia with 305 (14 per cent) (Table 8).

Table 8.

Data based on the choosing process and arranged by autonomous community and hospital in the present study.

Hospital	City	Minimum	p25	p50	p75	Maximum	Average	Positions
Andalucía: 330 positions in 15 hospitals
H. Universitario Virgen del Rocío	Sevilla	42	709	992	1331	2234	999	38
H. Universitario Virgen de la Victoria	Málaga	73	593	1081	1455	2543	1070	24
H. Universitario Virgen de las Nieves	Granada	8	764	1095	1616	2487	1131	28
H. Universitario Reina Sofía	Córdoba	6	1168	1752	2433	3387	1759	36
Aragón: 69 positions in 3 hospitals
H. Universitario Miguel Servet	Zaragoza	174	1389	1805	2257	3226	1753	40
H. Clínico Universitario Lozano Blesa	Zaragoza	1529	2009	2629	2857	3414	2510	20
H. Obispo Polanco	Teruel	1610	3444	3811	3858	4123	3381	9
Asturias: 62 positions in 2 hospitals
H. Universitario Central de Asturias	Oviedo	397	1471	1974	2562	3434	1965	42
H. Universitario de Cabueñes	Gijón	944	2342	2816	3450	3896	2737	20
Islas Baleares: 34 positions in 2 hospitals
H. Universitario Son Espases	Palma de Mallorca	280	1994	2654	2954	3704	2443	30
H. Son Llàtzer	Palma de Mallorca	2844	2882	3117	3524	3734	3203	4
Comunidad Valenciana: 218 positions in 10 hospitals
H. Universitari i Politècnic la Fe	Valencia	153	935	1315	1600	2264	1268	40
H. Universitario Doctor Peset	Valencia	159	993	1484	1670	2748	1352	38
H. General Universitario de Alicante	Alicante	139	1431	1977	2399	2920	1906	30
H. de la Ribera	Alzira	357	1532	2131	2787	3262	2074	16
Islas Canarias: 79 positions in 4 hospitals
H. Nuestra Señora de la Candelaria	Santa Cruz de Tenerife	488	617	996	2147	3465	1469	10
H. Universitario de Canarias	La Laguna	570	1664	2589	3117	3509	2355	20
C.H. Dr. Negrín	Las Palmas	732	2291	3066	3445	3861	2764	29
H. Universitario Insular de Gran Canaria	Las Palmas	631	2450	3145	3285	3884	2757	20
Cantabria: 30 positions in one hospital
H. Universitario Marqués de Valdecilla	Santander	73	812	1346	2413	2991	1485	30
Castilla la Mancha: 69 positions in 5 hospitals
C.H. Universitario de Albacete	Albacete	634	1505	2430	2994	3726	2268	18
C.H. de Toledo	Toledo	552	1843	2934	3175	3395	2575	23
H. General Universitario de Guadalajara	Guadalajara	2725	2979	3090	3191	3326	3061	10
H. General Universitario de Ciudad Real	Ciudad Real	851	2415	3115	3363	3406	2722	12
Castilla y León: 135 positions in 8 hospitals
H. Universitario del Río Hortega	Valladolid	208	950	2096	3131	3618	2093	10
H. Clínico Universitario de Valladolid	Valladolid	330	2183	2885	3186	3625	2600	20
Complejo Asistencial de León	León	496	2391	2802	3364	3867	2674	20
Complejo Asistencial Universitario de Salamanca	Salamanca	463	2323	3120	3462	3831	2830	40
Cataluña: 305 positions in 16 hospitals
H. Clínic de Barcelona	Barcelona	28	166	330	622	1095	401	30
H. Universitari Vall d’Hebron	Barcelona	334	870	1172	1413	2132	1165	49
Corporació Sanitària Parc Taulí	Sabadell	340	673	1094	1666	2404	1220	31
H. del Mar-Parc de Salut Mar	Barcelona	1202	1563	1708	1997	2668	1843	18
Extremadura: 35 positions in 3 hospitals
C.H. Universitario de Badajoz	Badajoz	210	1104	1584	2936	3613	1885	19
H. de Mérida	Mérida	1971	2005	3567	3783	3916	3090	7
C.H. de Cáceres	Cáceres	825	2549	3744	3801	3966	3102	9
Galicia: 144 positions in 13 hospitals
C.H. Universitario Coruña	La Coruña	252	779	952	1740	3071	1254	27
C.H. Universitario de Santiago de Compostela	Santiago de Compostela	412	1409	2035	2471	3568	2028	26
C.H. Universitario de Vigo^a	Vigo	1821	2388	2640	3172	3750	2748	30
H. Universitario Lucus Augusti^b	Lugo	2770	3026	3288	3732	3943	3346	10
La Rioja: 10 positions in 2 hospitals
H. de San Pedro^c	Logroño	1870	3404	3609	3690	3847	3338	6
C.H. San Millán^c	Logroño	2904	3232	3572	3757	3929	3494	4
Madrid: 432 positions in 14 hospitals
H. General Universitario Gregorio Marañón	Madrid	21	241	462	664	972	457	40
H. Universitario 12 de Octubre	Madrid	126	573	811	1010	1820	812	50
H. Universitario la Paz	Madrid	253	648	922	1144	1740	913	40
H. Universitario Clínico San Carlos	Madrid	98	768	1121	1354	1774	1053	50
Murcia: 76 positions in 3 hospitals
H. Clínico Universitario Virgen de la Arrixaca	Murcia	416	1338	2094	2765	3239	2033	40
H. General Universitario José M.ª Morales Meseguer	Murcia	1021	1840	2280	2677	3351	2265	27
H. General Universitario Reina Sofía de Murcia^d	Murcia	2096	2614	2908	3154	3786	2878	9
Navarra: 40 positions in 2 hospitals
Clínica Universidad de Navarra	Pamplona	52	506	2266	2610	3150	1694	20
C.H. de Navarra^e	Pamplona	200	979	2023	2775	3854	1894	20
País Vasco: 96 positions in 6 hospitals
H. Universitario Cruces	Barakaldo	53	610	1091	1628	2293	1108	28
H. Universitario Basurto	Bilbao	295	721	1093	1523	2227	1123	20
H. Universitario Donostia	Donostia-San Sebastián	284	981	1871	2518	3367	1817	28
H. de Galdakao	Galdakao	1277	1508	1943	2262	3599	2077	10

Here follows data from a 10 year study of hospitals with the lowest mean of position choosing in every autonomous community with a maximum of 4 hospitals. C.H.U.: Complejo Hospitalario Universitario; H., hospital; #, total amount of positions offered in this period; p25, percentile 25; p75, percentile 75; the name of each training center as provided by the Ministry in its public offering with the following center group is the name that has been taken into consideration:

a

Vigo has experienced the merge of various hospitals with several changes in the denomination of public hospitals and the training offer for the candidates, so for better clarification purposes, the positions offer has beed divided based on whether such offer comes from the Hospital Policlínico de Vigo (POVISA) or the Complejo Hospitalario Universidad de Vigo – including the offer by the Xeral-Cíes and Meixoeiro hospitals.

b

In Lugo, the actual Hospital Universitario Lucus Augusti is referred to in the public announcements as C.H. Universitario Xeral–Calde de Lugo.

c

C.H. San Millán and H. de San Pedro should be considered as the same hospital due to name change; consequently the autonomous community of La Rioja has had one resident per year only.

d

The Hospital General de Murcia has changed its name into Hospital General Universitario Reina Sofía.

e

The actual Complejo Hospitalario de Navarra is the combination of two hospitals. On the one hand, Hospital de Navarra (Provincial) and on the other hand, Hospital Virgen del Camino.

The hospital chosen with the lowest number of order mean (best number) is Hospital Clínic de Barcelona, followed by three (3) hospitals from Madrid: Hospital Universitario Gregorio Marañón, Hospital Universitario 12 de Octubre, and Hospital Universitario La Paz (Table 9).

Table 9.

Hospitals with an position pick mean <2500 regardless of the amount of positions offered.

Number of order	Hospital ranking per p50 of number of order MIR 06–15	Autonomous community	City	Min.	p25	p50	p75	Max	Average	Positions
1	H. Clínic de Barcelona	Cataluña	Barcelona	28	166	330	622	1095	401	30
2	H. General Universitario Gregorio Marañón	Madrid	Madrid	21	241	462	664	972	457	40
3	H. Universitario 12 de Octubre	Madrid	Madrid	126	573	811	1010	1820	812	50
4	H. Universitario la Paz	Madrid	Madrid	253	648	922	1144	1740	913	40
5	C.H. Universitario a Coruña	Galicia	La Coruña	252	779	952	1740	3071	1254	27
6	H. Universitario Virgen del Rocío	Andalucía	Sevilla	42	709	992	1331	2234	999	38
7	H. Nuestra señora de la Candelaria	Islas Canarias	Santa Cruz de Tenerife	488	617	996	2147	3465	1469	10
8	H. Universitario Virgen de la Victoria	Andalucía	Málaga	73	593	1081	1455	2543	1070	24
9	H. Universitario Cruces	País Vasco	Barakaldo	53	610	1091	1628	2293	1108	28
10	H. Universitario Basurto	País Vasco	Bilbao	295	721	1093	1523	2227	1123	20
11	Corporació Sanitària Parc Taulí	Cataluña	Sabadell	340	673	1094	1666	2404	1220	31
12	H. Universitario Virgen de las Nieves	Andalucía	Granada	8	764	1095	1616	2487	1131	28
13	H. Universitario Clínico San Carlos	Madrid	Madrid	98	768	1121	1354	1774	1053	50
14	H. Universitario Vall d’Hebron	Cataluña	Barcelona	334	870	1172	1413	2132	1165	49
15	H. Universitario Ramón y Cajal	Madrid	Madrid	343	827	1195	1610	2303	1239	40
16	H. Universitari i Politècnic la Fe	Valencia	Valencia	153	935	1315	1600	2264	1268	40
17	H. Universitario Marqués de Valdecilla	Cantabria	Santander	73	812	1346	2413	2991	1485	30
18	H. Universitario Puerta de Hierro	Madrid	Madrid	185	706	1372	1651	2184	1218	30
19	H. Universitario de la Princesa	Madrid	Madrid	464	1000	1475	1792	1937	1356	30
20	Fundación Jiménez Díaz	Madrid	Madrid	532	722	1483	1839	2638	1412	20
21	H. Universitario Doctor Peset	Valencia	Valencia	159	993	1484	1670	2748	1352	38
22	C.H. Universitario de Badajoz	Extremadura	Badajoz	210	1104	1584	2936	3613	1885	19
23	H. del Mar-Parc de Salut Mar	Cataluña	Barcelona	1202	1563	1708	1997	2668	1843	18
24	H. Universitari de Bellvitge	Cataluña	Hospitalet de Llobregat	577	1057	1723	2164	2573	1594	36
25	H. Universitari Germans Trias i Pujol	Cataluña	Badalona	683	1497	1751	2249	2744	1804	20
26	H. Universitario Reina Sofía	Andalucía	Córdoba	6	1168	1752	2433	3387	1759	36
27	H. Universitario Miguel Servet	Aragón	Zaragoza	174	1389	1805	2257	3226	1753	40
28	H. de la Santa Creu i Sant Pau	Cataluña	Barcelona	123	1495	1846	2155	2601	1741	32
29	H. Universitario Donostia	País Vasco	Donostia-San Sebastián	284	981	1871	2518	3367	1817	28
30	H. de Galdakao	País Vasco	Galdakao	1277	1508	1943	2262	3599	2077	10
31	H. Santiago Apóstol	País Vasco	Vitoria-Gasteiz	1966	1966	1966	1966	1966	1966	1
32	H. Universitario Central de Asturias	Asturias	Oviedo	397	1471	1974	2562	3434	1965	42
33	H. General Universitario de Alicante	Valencia	Alicante	139	1431	1977	2399	2920	1906	30
34	H. Universitario de Getafe	Madrid	Getafe	852	1569	2016	2268	2766	1977	30
35	C.H. de Navarra	Navarra	Pamplona	200	979	2023	2775	3854	1894	20
36	C.H. Universitario de Santiago de Compostela	Galicia	Santiago de Compostela	412	1409	2035	2471	3568	2028	26
37	H. Universitario Fundación Alcorcón	Madrid	Alcorcón	989	1808	2036	2298	2694	1993	20
38	H. Regional Universitario de Málaga	Andalucía	Málaga	311	1534	2063	2640	3280	2028	44
39	H. Clínico Universitario Virgen de la Arrixaca	Murcia	Murcia	416	1338	2094	2765	3239	2033	40
40	H. Universitario del Río Hortega	Castilla León	Valladolid	208	950	2096	3131	3618	2093	10
41	H. Universitario Araba	País Vasco	Vitoria-Gasteiz	1353	1699	2104	2887	3549	2252	9
42	H. Universitario Ntra. Sra. de Valme	Andalucía	Sevilla	1114	1628	2111	2628	3046	2080	20
43	H. de la Ribera	Valencia	Alzira	357	1532	2131	2787	3262	2074	16
44	H. Clínico Universitario de Valencia	Valencia	Valencia	329	1771	2135	2493	2841	2065	28
45	Clínica Universidad de Navarra	Navarra	Pamplona	52	506	2266	2610	3150	1694	20
46	H. General Universitario José M.ª Morales Meseguer	Murcia	Murcia	1021	1840	2280	2677	3351	2265	27
47	H. Universitario Virgen Macarena	Andalucía	Sevilla	1409	1808	2293	2562	3028	2254	30
48	H. Universitario Puerta del Mar	Andalucía	Cádiz	780	1754	2299	2883	3228	2253	27
49	H. General Universitario de Valencia	Valencia	Valencia	1852	2220	2374	2689	3203	2412	19
50	H. Universitario Severo Ochoa	Madrid	Leganés	1914	2024	2375	2480	2828	2318	20
51	H. Universitario San Cecilio	Andalucía	Granada	481	1828	2380	2776	3091	2195	20
52	H. Universitari Sagrat Cor	Cataluña	Barcelona	1757	2019	2384	2666	2822	2355	7
53	C.H. Universitario de Albacete	Castilla la Mancha	Albacete	634	1505	2430	2994	3726	2268	18
54	H. Universitario de Fuenlabrada	Madrid	Fuenlabrada	2184	2386	2493	2687	3014	2540	17
55	H. Costa del Sol	Andalucía	Málaga	1798	2092	2497	3005	3330	2539	8

Here follows data from a 10 year study of hospitals with the lowest mean of position choosing in every autonomous community with a maximum of 4 hospitals. C.H.U., Complejo Hospitalario Universitario; H., hospital; #, total amount of positions offered in this period; p25, percentile 25; p75, percentile 75; the name of each training center as they appear in the public offer by the Ministry is the one that has been considered with the following center grouping:

^a Vigo has experienced the merge of various hospitals with several changes in the denomination of public hospitals and the training offer for the candidates, so for better clarification purposes, the positions offer has beed divided based on whether such offer comes from the Hospital Policlínico de Vigo (POVISA) or the Complejo Hospitalario Universidad de Vigo - including the offer by the Xeral-Cíes and Meixoeiro hospitals.

^b In Lugo, the actual Hospital Universitario Lucus Augusti is referred to in the public announcements as C.H. Universitario Xeral–Calde de Lugo.

^c C.H. San Millán and H. de San Pedro should be considered as the same hospital due to name change; consequently the autonomous community of La Rioja has had one resident per year only.

^d The Hospital General de Murcia has changed its name into Hospital General Universitario Reina Sofía.

^e The actual Complejo Hospitalario de Navarra is the combination of two hospitals. On the one hand, Hospital de Navarra (provincial) and on the other hand, Hospital Virgen del Camino.

Discussion

The specialty of diagnostic radiology is one of the classic specialties that started offering traning positions for specialized physicians back in the 1980s. We have picked the last ten (10) years for our study for two reasons: because they are pretty homogeneous in the positions offer with respect to the total, and because there are no significant variations in its geographic distribution.

The amount of positions offered for all medical specialties varies on a yearly basis. For example, in the MIR exam 2015, 12,427 physicans were admitted to take the test for a total of 6097 positions and 11,227 physicians attended the exam. Out of all the physicians who attended the exam, 9288 obtained a number of order (potential candidates) in the lists of definitive results from the Ministry after the application of the cut-off mark (65.67 net questions), while 1939 physicians were disqualified because their score in the exam was not above the cut-off mark. In the MIR exam 2015, the last position of all the opernings offered was chosen with number of order 7759 (physicians unaffected by the ratio of foreign candidates), and with number of order 4547 (physicians affected by the ratio of foreign candidates). The ratio of foreign candidates ranges between 10 per cent in the year 2010, and 4 per cent from 2014 until present day.

The number of positions offered for diagnostic radiology ranges between 207 and 230, with a maximum amount of positions offered in the years 2008 and 2009 and then a drop until 207 in 2014. This oscillation in the number of positions for the specialty of diagnostic radiology is directly proportional to the total number of positions offered, because if we analyze the percentage of annual positions, the value is nearly stable at 3.36 per cent (Fig. 1). This stability is constant in most medical specialties, though there are cases like the specialty of clinical laboratory that offered some 35 positions in the year 2007 but that has been reduced to only 18 positions in 2015. Other medical specialties like digestive system, pneumology, and pediatrics have increase their percentage of annual positions; these variations occur based on estimation researches conducted by the Ministry on the need for specialists^14–16.

In the classification of specialties arranged by number of order mean for all candidates, the specialty of diagnostic radiology ranks #16 among the 47 medical specialties offered, which is a stable position when all medical specialties are arranged by number of order mean of the candidates who chose them, or by percentiles 25, 50, or 75 for number of order.

The first candidate who is eligible to choose diagnostic radiology usually scores in over 170 net questions, except for the year 2009 when the maximum score dropped to 164 net questions; 25 per cent of all positions have already been covered by the time candidates score in 150 net questions, and the last position by the time they score in over 100 net questions. Comparing these data with the simulation for exams of 225 questions as shown in Fig. 2, we see that to be eligible for the very first position in diagnostic radiology, the candidates’ scores need to be among the top 75 exams, that 25 per cent of the positions have been covered by the time the numbers of order reach numbers 1016 and 1296 and that the last position is usually above the average and mean of candidates between the numbers of order 3715 and 4066. The surveys published by the Ministry confirm that 78 per cent of the candidates who choose diagnostic radiology say that such medical specialty was their very their first choice.^14,15 Also these surveys confirm that diagnostic radiology is one of the most popular medical specialties, far from specialties such as family and community medicine, or internal medicine. The average age of the candidates is 28 years old–well above the average age of medical college graduates, suggestive that the average candidate is savvy on diagnostic radiology, that he or she has followed special training and that he/she has not finished such training until the completion of this specialty.^14,15 As the surveys from the Ministry claim, the main issue here is trying to generalize these outcomes to the overall population of candidates, since only the candidates who answer these surveys are included.¹⁴

Figure 2.

Simultation of MIR exams as if they consisted of 225 questions (it only happens since 2009) and the cut-off mark was stable at 35 per cent. Compiled and edited from https://gangasmir.blogspot.com.es/. The MDME is the average grade of the top ten (10) exams, and the cut-off mark was 35 per cent of the MDME grade in the 2013–2015 period, and 30 per cent in 2012. From 2008 through 2012 the cut-off mark was the minimum positive grade only, while from 2001 through 2007 there was not cut-off mark.

Twenty four per cent of all diagnostic radiology positions are chosen by foreign physicians–which makes this specialty rank #21 in the overeall classification of 44 offered medical specialties (excluding the specialties offered by professional schools) arranged from lower to higher percentage of foreign physicians, which is suggestive that diagnostic radiology is an intermediate option for foreign candidates living in Spain. Always taking into account that the ratio of foreign physicians conditions access of such physicians to the medical specialties and that only those with low numbers of order have access to specialized training.

Every year the amount of women who choose diagnostic radiology exceeds the number of men who do so, and in the year 2012 it reached its peak with 65 per cent of all positions offered (Tables 3 and 5). Diagnostic radiology ranks #33 in the ranking of medical specialties arranged from lowest to highest presence of female physicians. This is indicative that the feminization of diagnostic radiology is lower than the feminization of most specialties. The largest presence of masculine candidates who choose diagnostic radiology has been reported in descriptive studies conducted in the United States, though countries like Switzerland report different results.^8–10 The studies published by the Ministry reveal that there are 49 per cent of female specialists in diagnostic radiology today, there will be 48.4 per cent by 2020, and 47.2 per cent by 2025, meaning that we will witness a slight drop of women who choose this specialty.^14,15 We have not found any sources that give a clear explanation for this finding which is particulary unsual given the benefits associated with this specialty that ease the family responsibility of women, which should rise the percentage of women who choose this specialty.^9,10 Barriers in the advancement of women in the field of academic radiology have been proposed as one of the possible reasons, though without specific data,⁹ as well as the low satisfaction of female radiologists in their job¹⁷ and even that this type of technology is not appealing to female physicians anymore.¹⁰ Other studies talk about meeting this specialty for the first time in the colleges of medicine, and about the low exposure of candidates to female specialists in diagnostic radiology during training.¹⁰ In any case, in our study we have not found any justification or conclusive reason to explain this.

The first autonomous community in the number of positions offered in diagnostic radiology in 10 years of study is Madrid with 432 posititions distributed in 14 hospitals. Up to 130 of these positions are offered by (3) hospitals from the Comunidad de Madrid, that cover all positions with a number of order mean below 1000 (Hospital General Universitario Gregorio Marañón, Hospital Universitario 12 de Octubre, and Hospital Universitario la Paz).

Andalucía is the second autonomous community in the number of positions offered during the 2006–2015 period: 330 positions distributed in 15 hospitals. Two (2) hospitals from Andalucía reported a number of order mean below 1000: Hospital Universitario Virgen del Rocío de Sevilla, with 38 residents in 10 years, and Hospital Universitario Virgen de la Victoria de Málaga, with fewer residents per year, and a total of 24 residents in 10 years.

The hospital with the best number of order mean in this classification is Hospital Clínic de Barcelona with a number of order mean among candidates of 330. Catalonia is the third autonomous community in the number of positions offered (305) in the studied period.

The fourth autonomous community in the number of positions offered for residents is Comunidad Valenciana (218 positions), distributed in 10 hospitals. The hospital with the lowest number of order mean is Hospital Universitari i Politècnic la Fe with 1.315 and 40 residents trained in 10years.

This list of hospitals with a number of order mean below 1000 is completed with Hospital Universitario de la Coruña, with a percentile 50 of 952 and 27 residents trained during the 10 years of study, and Hospital Nuestra Señora de la Candelaria with a number of order mean of 996, though with a significantly lower number of residents trained – 10 residents in 10 years. The Basque Country has been offering 96 positions during these 10 years and two (2) of its hospitals complete the classification of the 10 hospitals with the lowest percentile 50 of number of order: Hospital Universitario de Cruces, with a number of order mean of 1081 and 28 residents trained in 10 years, and Hospital Universitario de Basurto with a number of order mean of 1093 and 20 residents trained in the 10 years of the study. The first hospital of one mono-provincial autonomous community is Hospital Universitario Marqués de Valdecilla, with a number of order mean of 1346 and 30 residents trained in 10 years.

Consequently, we can deduce that the candidates of the specialty of diagnostic radiology prefer to do their medical residency in large volume hospitals like those located in provincial capital cities. This statement is a constant in the process of choosing all medical specialties since all surveys pubished by the Ministry and conducted among training specialists claim that if candidates were free to choose, the first three hospitals they would choose from are (1) Hospital Universitario La Paz, (2) Hospital Clínic de Barcelona, and (3) Hospital 12 de Octubre.^14,15

What physicians look for when they choose position and place of residence is personal and varies from one physician to the other. In Spain, specialized healthcare training is strictly characterized by the process of choosing position, and by the number of order obtained in the MIR exam, something that does not happen in other settings. According to the surveys conducted by the Ministry, up to 40 per cent of the residents said that they chose their medical specialty based on career opportunities, professional development, and future of such medical specialty, 17 per cent chose their medical specialty on grounds of social recognition, and 9 per cent for the prestige they were going to get from family and friends^14,15; also other variables such as “because the hospital offering this specialty is highly advanced”^4–7,12,13 were studied too. Probably, all the aforementioned motivations make candidates choose hospitals located in provincial capital cities that are closer to their main future goals, with more technological advancements, and career opportunities.

In these studies the influence of medical schools has not been analyzed, and yet they play a role in the candiates’ process of choosing probably because they choose hospitals they knew during their college training versus unknown hospitals of similar characteristics.

In any case, we cannot ignore the territorial reality of Spain or the personal characteristics of each candidate that make some hospitals fall outside this general rule. According to surveys from the Ministry, up to 23 per cent of the candidates choose their training center because it is close to their place of residence and because they want to be close to their families. These personal of family motivations are often quoted among the most important ones in studies that analyze how the process of choosing this or that center to complete the specialty unfolds, such as one survey conducted in Germany where respondants said that both family and leisure opportunities are more important than social status, scientific work, or mentoring. One Australian study that analyzed the reasons to choose diagnostic radiology says that what is perceived as the most important of all is how the specialty will shape family life, and how it is an organized job with a flexible schedule to which one can return easily after a period of absence.^11,13

On the other hand, in the surveys published by the Ministry, training specialists say that money is not the main motivation to choose diagnostic radiology in any of surveys conducted through the years.^14,15 But this cannot be ignored when making the decision of specializing in diagnostic radiology since the prospect of good career opportunities when completing the specialty is among the main motivations as reported by the specialists - up to 10 per cent of the respondents.¹⁴ Our specialty offers the appropriate career opportunities if we consider that the Ministry of Health thinks that by offering positions in the MIR training exam in diagnostic radiology there is already a balance between training and the withdrawal of specialists, unlike what happens in other specialties with training surplus like allergology or negative balance like pediatrics.¹⁵

The main difficulties we had while conducting this study are the lists including the positions to choose from published by the Ministry that happen to be available only for a short period of time in the official website of the Ministry of Health. We had to conduct annual registrations of these lists while the position choosing events of each year were taking place for further grouped data analysis.

Hospital classification by number of order mean of the candidates is biased due to the different number of positions offered every year in each center. The number of order mean of the candidates of one center used to elaborate the ranking is not as important if such estimate derives from a high number of positions offered by large volume centers compared to a low number of positions offered by small volume centers. In the latter case, the results from one or few candidates may dramatically modify the mean value (up or down).

Lastly, there is significant bias in the statistics of the different positions available due to hospital merge processes. The motivations of the candidates are not the same in old compared to new hospitals or hospital merges, even if both the setting and personnel stay the same. So, as far as possible, we tried to keep those institutions with a different denomination in the public announcement separately, except for certain occasions whose special characteristics are described herein.

In conclusion, candidates eligible for the medical specialty of diagnostic radiology need good numbers of order in the MIR exam, and the specialty is usually chosen by Spanish physicians, but not so much by women. Also, those eligible for the specialty of diagnostic radiology prefer large volume hospitals located in provincial capital cities.

Ethical responsibilities

Protection of people and animals

The authors declare that no experiments with human beings or animals have been performed while conducting this investigation.

Data confidentiality

The authors confirm that in this article there are no data from patients.

Right to privacy and informed consent

The authors confirm that in this article there are no data from patients.

Authors’ contribution

• 1.

  Manager of the integrity of the study: EMQ.

• 2.

  Study idea: EMQ, JBR.

• 3.

  Study design: EMQ, JBR.

• 4.

  Data mining: EMQ, JBR, FSL, JMRL.

• 5.

  Data analysis and interpretation: EMQ, FSL, AFS, JMRL, MCR.

• 6.

  Statistical analysis: EMQ, FSL, JMRL.

• 7.

  Reference: EMQ.

• 8.

  Writing: EMQ, SCG, JBR, MCR, AFS, SCG.

• 9.

  Critical review of the manuscript with intellectually relevant remarks: MCR, JBR, AFS, FSL, JMRL, MCR, SCG.

• 10.

  Approval of final version: all authors.

Conflicts of interests

The authors declare no conflict of interests associated with this article whatsoever.

Acknowledgements

We wish to thank Ms. Conchi García, Head of the Spanish Medical Residency Examination (MIR Asturias).