Public Health as a Career of Medicine: Secondary Choice Within a Profession

ONE of the striking features of contemporary society is the multitude of distinct occupations. The Dictionary of Occupational Titles lists almost 25,000 different occupations, and other detailed classifications reach similar numbers. This fact alone suggests the difficulty of rational occupational choices. Not only is the number of alternatives beyond the ability of the individual to assess, but many occupations are completely unfamiliar to most people. Many of the day-to-day activities and requirements for success in even relatively familiar occupations are virtually unknown. The image of an occupation is primarily defined for the prospective entrant by those of its activities which are known to the general public, either directly or through media of communication. Training for occupations typically is acquired with respect to "jobfamilies" and not for specific occupations. Vocational preparation and occupational choice are rarely made for a highly specific occupation: few people prepare themselves and make plans for becoming refrigerator repairmen, stock analysts, or public health officers; more likely they think of preparing for mechanical work, business, or medicine. Thus, a prospective entrant into the labor force usually is unfamiliar with the many possible fields open to him and has a vague or distorted view of those occupations with which he is relatively familiar. Even when he is undergoing training, his perception of the specific fields to which his training leads him and his possible or probable satisfaction with these fields are unclear. Given this situation, it is exceedingly difficult for the individual to end up in a specific field which is "ideal" for him. Specialization is often viewed as a functional process for an economic system. However, the functions it fulfills for the individual also should be carefully examined. By providing a series of alternatives for the person who has already chosen a general field, specialization allows him to make secondary choices which can result in closer approximation to an optimum choice. No matter how far removed the primary choice may be from an individual's own interests and abilities, there is the possibility of one or a series of secondary choices which can, at least partially, close this gap. Most theories of vocational selection stress that it is a continuing process, developing from general, vague and unrealistic choices to specific and realistic ones, Ginzberg,' for example, distinguishes three periods: fantasy choices, tentative choices, and realistic choices. Caplow 2 criticizes the notion that these stages invariably occur, viewing occupational selection more as a continuous process, especially within the educational system. Super 3 relates voca* Based on paper presented at the annual meeting of the American Sociological Society, Washington, D. C., August, 1957. The research program reported here is supported by a grant from the National Institute of Health, U. S. Public Health Service. It was developed under the auspices of the Subcommittee on Recruitment of the Committee on Professional Education of the American Public Health Association under the Chairmanship of Franklyn B. Amos, M.D. The Chairman of the Subcommittee's special study group which developed the plan for the research is John H. Venable, M.D. The original concept of the study came from the Public Health Education Branch, Division of Public Health Methods, U. S. Public Health Service, Mayhew Derryberry, Ph.D., Chief. Substantial contributions have been made to the project and to the development of this paper by Bernard G. Greenberg. 1 E. Ginzberg, S. W. Ginsburg, S. Axelrod, and J. L. Herma, Occupational Choice, An Approach to a General Theory, New York: Columbia University Press, 1951. 2 T. Caplow, The Sociology of Work, Minneapolis: University of Minnesota Press, 1954. 3D. E. Super, The Psychology of Careers, New York: Harper Brothers, 1957.