Occupational experiences and career decisions among paediatricians: a qualitative study

China continues to face shortages and uneven distribution of paediatricians, making retention an important workforce concern. This study explored perceptions of paediatric work and accounts of career decisions, with particular attention to longer-term career considerations among residents and occupational transitions among former paediatricians. A qualitative descriptive study was conducted in Guangdong, China, between July and August 2024. Semi-structured interviews were conducted with 15 participants: eight paediatric residents, five former paediatricians no longer working in paediatric clinical roles, and two practising paediatricians. The two practising paediatricians provided contextual accounts of current practice and were not treated as a separate comparison group. Data were analysed using a team-based codebook approach to thematic analysis informed by Braun and Clarke’s six-phase framework. Six themes captured professional meaning and emotional strain; assessment and communication demands in child–family care; workload and constraints on rest and family life; rewards and support that did not consistently match work demands; variation in the certainty and enactment of career decisions; and proposed changes to support retention. Some residents distinguished completing residency from deciding whether to remain in paediatrics long term. Former paediatricians described transitions away from paediatric clinical work, with their accounts linking these changes to sustained workload, work–family conflict and limited career development opportunities. Participants proposed improvements in remuneration, staffing, scheduling and wider organisational support to strengthen retention. These findings suggest that recruitment and longer-term retention should be addressed together in paediatric workforce planning. Attention to post-entry working conditions, particularly staffing, scheduling, remuneration and opportunities for professional development, should accompany recruitment initiatives.