This study examined specialty preferences, willingness to pursue residency training, and the main motivating and discouraging factors among interns at Hormozgan University of Medical Sciences. Overall, the findings suggest that specialty choice is a multifactorial decision shaped primarily by economic considerations, perceived job opportunities, social prestige, and lifestyle-related expectations, rather than by basic demographic or academic characteristics alone. These findings are important because the specialty preferences of current medical students contribute directly to the future composition of the physician workforce, and imbalances in specialty distribution may ultimately affect health system performance and access to care [1, 23]. Specialty choice has long been recognized as a key stage in medical career development. A central finding of the present study was that a majority of students expressed interest in pursuing specialty training. This is generally consistent with reports from many settings indicating that interest in specialization has increased over time [5].

In the present study, students’ preferences were concentrated in specialties such as radiology, otorhinolaryngology, dermatology, and cardiology, whereas several other specialties attracted little or no interest. This pattern is noteworthy because it appears to differ from the traditional dominance of major or highly demanding specialties reported in older literature [11, 12]. The current findings instead suggest a shift toward specialties perceived as offering more favorable working conditions, more controllable lifestyles, and attractive financial prospects [14]. This pattern is in line with more recent international evidence showing that younger physicians increasingly value work-life balance alongside income and prestige [24]. In this framework, specialties such as dermatology, ophthalmology, and radiology have become especially attractive because they are often associated with more predictable schedules, less physically demanding workloads, and comparatively favorable remuneration. This shift away from some major specialties may reflect several realities experienced by students during clinical training. Prolonged exposure to demanding hospital environments, heavy workloads, high emotional burden, difficult interpersonal climates in some departments, and concerns about unclear or stressful future career conditions may all reduce the attractiveness of more intensive specialties [7]. In addition, limited or uneven exposure to certain specialties during clinical rotations may influence students’ awareness of those fields and reduce the likelihood that they will consider them seriously [25]. Thus, specialty preference may be shaped not only by the inherent nature of a field, but also by the quality and extent of students’ contact with it during undergraduate training.

Economic considerations emerged as one of the strongest themes in this study, both among students interested in specialty training and among those who were hesitant or unwilling to continue. This finding is highly meaningful in the context of medical education, where students spend many years in training before reaching stable income. The long educational pathway in medicine can create pressure to choose specialties that promise faster financial return, greater earning potential, or more secure employment opportunities. Conversely, when the perceived financial burden of continued training is high, motivation to pursue residency may decline. The prominence of financial factors in the present study is therefore consistent with previous research showing that income expectations, living conditions during residency, and anticipated future earnings are major determinants of specialty preference [1, 4, 26–30]. The importance of economic motives in this study should not be interpreted narrowly as simple materialism. Rather, it may reflect a broader concern with long-term professional stability, independence, and quality of life. Students often evaluate specialties not only in terms of scientific interest, but also in relation to the years required for training, the financial sacrifices expected during residency, and the sustainability of the eventual career path. This interpretation is supported by another finding of the present study: Under more favorable conditions, for both students who were willing and those who were unwilling to pursue specialty training, economic considerations were the most frequently reported motivation for continuing specialty education.

Another important finding was that fatigue from studying was one of the most common reasons for not pursuing specialty training. This result highlights the role of academic burnout in medical career decision-making. The prolonged duration of medical education, repeated high-stakes evaluations, and cumulative psychological and physical demands of the clinical years may contribute to exhaustion by the end of internship. For some students, the prospect of entering another long and demanding period of residency training may therefore be discouraging, even if they remain interested in medicine as a profession. Similarly, the preference of some students to enter the job market immediately after graduation may represent both economic necessity and a desire to regain control over time, income, and personal life after years of intensive education. The findings also support the growing importance of lifestyle considerations in specialty choice. Although the questionnaire did not directly measure “controllable lifestyle” as a separate variable, the pattern of preferred specialties and the reasons reported by students strongly suggest that this concept is highly relevant. Recent studies in different countries have likewise shown that younger generations of medical trainees increasingly prioritize manageable work hours, reduced on-call burden, and the possibility of balancing professional and personal responsibilities [30, 31] and some research show rising regret rates in medical residents [32–34]. This trend may help explain declining interest in more demanding or stressful specialties and growing interest in fields traditionally associated with more regular schedules.

Immigration was an important reason for unwillingness to pursue specialty training in a notable minority of interns in our study. While less common than fatigue and financial concerns, this finding is broadly consistent with a recent study [35] among Iranian residents reporting high immigration willingness, and may indicate that immigration-related thinking begins to affect career decisions even before residency entry. In the context of the broader and ongoing brain drain in Iran, this finding warrants particular attention from policymakers. Efforts to strengthen the medical workforce should therefore address conditions that may encourage young physicians to consider leaving the country, thereby increasing the risk of future medical workforce loss.

In the present study, no statistically significant independent association was found between willingness to pursue specialty training and demographic or academic variables such as age, sex, entrance examination rank, admission quota, or GPA in the final regression model. This finding reinforces the idea that specialty choice is a complex process not easily explained by a limited set of measurable background variables. Although GPA categories showed temporary significance in the age- and sex-adjusted model, this relationship did not persist in the final multivariable analysis. The absence of stable predictors suggests that unmeasured factors—such as personality traits [36, 37], lifestyle values [38], role models [39, 40], prior clinical experiences [9, 10], perceptions of residency culture, and broader cultural expectations—may play a more important role.

The lack of a significant gender difference in the present study is also notable. In many previous studies, gender has been reported as an important factor in specialty choice, often with female students showing greater preference for specialties compatible with family life and less preference for highly demanding or time-intensive fields [5, 15, 24, 41]. In our study, however, such a difference was not statistically evident. This may indicate changing patterns of expectation among both male and female students, or it may reflect the limited sample size and local context. Therefore, although gender did not emerge as an independent predictor here, it should not be dismissed as irrelevant without further multicenter and larger-scale investigation.

Similarly, marital status was not identified as an independent predictor in the final model, but it remains conceptually important. Family responsibilities, emotional support, financial stability, and future household planning may all influence decisions about whether and when to enter specialty training. In this sense, the absence of a statistical association in the present sample should be interpreted cautiously. Such factors may operate indirectly or interact with variables not captured in this study [8, 24].

The relatively lower importance of family recommendation compared with financial and personal motives is another meaningful finding. It suggests that, in this group of students, specialty selection was driven more by individual career planning than by direct family pressure. Nevertheless, the broader literature indicates that family background may still matter, especially when students have physician parents or close relatives who can serve as role models, provide information about certain specialties, or create practical opportunities for future professional entry [29, 42]. Therefore, family influence may be subtle and indirect rather than explicitly stated by students.

These findings also draw attention to the possible role of educational counseling and career guidance. In many medical schools, students receive insufficient structured information about the full range of available specialties, the realities of residency training, and long-term career trajectories [1]. In such situations, students may rely heavily on informal student culture, departmental atmosphere, anecdotal impressions, or short-term experiences during rotations [25]. This may lead to exaggerated enthusiasm for some specialties and unfair discouragement from others. A lack of formal advising may also result in mismatch between a student’s personality, values, capabilities, and eventual specialty choice. Individual or group-based career counseling, mentorship from faculty, and structured orientation sessions about residency options may therefore improve the quality of decision-making and lead to better alignment between student preferences and health system needs [43].

From a policy perspective, the findings have several implications. First, the concentration of interest in a limited number of specialties and the low attractiveness of several others may contribute over time to imbalances in the physician workforce. If such patterns continue, some fields may face oversupply while others experience persistent shortages [13]. Second, because economic concerns were strongly linked to both willingness and unwillingness to continue specialty training, policymakers should consider improving financial support mechanisms, residency conditions, and future career incentives in less popular specialties. Third, because clinical exposure appears to shape preferences substantially, improving the educational environment of clinical departments may influence how students perceive different specialties.

This study has several strengths. One important strength is the high response rate, which may have been facilitated by careful electronic distribution of the questionnaire to students on an individual basis. Although this method was time-consuming, it appears to have improved participation and reduced missing data. Another strength is the inclusion of students in the internship stage, which is an especially relevant period for assessing specialty intention because students have already experienced substantial clinical exposure and are closer to making actual residency decisions.

At the same time, several limitations should be acknowledged. First, the cross-sectional design does not allow causal inference and cannot capture how preferences may change over time. Specialty interest is dynamic, and a longitudinal design would provide a clearer understanding of how clinical experiences, life events, and educational progression influence decision-making [44–46]. Second, the sample size was relatively small, which may have limited statistical power, particularly in regression analyses and subgroup comparisons. Third, the study was conducted in a single university, and therefore the findings may not be fully generalizable to students in other parts of Iran or in different educational settings. Multicenter studies with larger and more diverse samples are needed to examine whether the observed pattern is specific to this setting or reflects a broader trend.

Future research should therefore move in several directions. Studies involving multiple universities, including both public and private institutions, would improve generalizability. Longitudinal studies following students from pre-clinical years through internship and into residency application would be especially valuable for documenting changes in specialty preference over time. It would also be useful to examine factors not directly assessed in the present study, such as personality dimensions, perceived departmental climate, exposure to role models, and family medical background.