From Optimism to Prioritization: A Comparative Study of First- and Final-Year Medical Students’ Interest in Physician Leadership Roles

Purpose Physician involvement in healthcare leadership is essential for improving healthcare systems, yet medical students’ interest in future leadership roles is underexplored. This study aimed to examine first- and final-year medical students’ interest in leadership roles. Methods In 2021, online questionnaires were distributed to both cohorts, yielding response rates of 94% (109/116) and 87% (95/109), respectively. A mixed-methods approach was employed to examine leadership interest. Free-text responses were first analyzed through inductive content analysis and subsequently, a quantification analysis was performed. Cohort comparisons were conducted to evaluate differences, and age and gender data were collected as background variables. Results First-year students exhibited greater optimism, viewing leadership as a natural extension of their careers. Final-year students increasingly prioritized clinical roles, reflecting the influence of physicians’ identity formation and the demands of clinical practice. Final-year students exhibited lower levels of strong interest in leadership and higher levels of disinterest than first-year students. The quantified results aligned with these findings, as 38.5% of first-year students expressed strong interest, compared with 30.5% of final-year students. Conditional interest was higher among first-year students (30.3%) than among final-year students (24.2%), whereas disinterest was higher among final-year students (37.9%) than among first-year students (24.8%). Uncertainty regarding leadership roles was observed in both groups (6.4% of first-year and 7.4% of final-year students). Conclusions Differences in leadership interest suggest that increasing clinical responsibilities and physicians’ identity formation may influence students’ interest in leadership roles. Integrating early and longitudinal leadership education into clinical practice—emphasizing its clinical relevance and alignment with physicians’ professional identity—may help sustain interest, support career-aligned leadership decisions, and better prepare future physician leaders.