Enthusiasm and structural frustration? Insights from an exploratory cross-sectional two-cohort study into career decision-making and retention factors in German neurology.

Germany faces critical physician shortages in Neurology. This exploratory study examined factors influencing career decision-making across the Neurology training pipeline in a university setting to inform workforce development strategies. We conducted a cross-sectional two cohort study employing a mixed-methods approach surveying medical students (n = 79) and Neurology residents (n = 56) at German University hospitals via structured questionnaires and open-ended questions. The response rates were 44 % (medical students) and 32 % (residents). The important factors influencing career and medical specialization choices were the specialty itself, good teaching experiences and workplace conditions. Students showed high career motivation. Residents maintained high levels of engagement and specialty loyalty while reporting severe structural deficits in their everyday worklife and residency program. Evidence-based interventions could address these deficits.