Background/purpose: Identification of those factors which influence career choice will help to avoid a shortfall in surgical recruitment. We aimed to determine the views of medical students and junior doctors regarding influences on their career aspirations, such that potential disincentives to a career in surgery could be identified.Methods: A structured questionnaire was distributed in paper-form and online. 290 respondents were asked to score 20 items regarding influence on their career aspirations using Likert-scales ranging from 1 (no influence) to 5 (strong influence). Stepwise regression was employed to determine those factors most important when considering a surgical career.Results: The response rate was 84%. 13.2% of respondents felt they would choose surgery, with males more likely to see it as a realistic career choice (p = 0.006). Factors which most influenced career choice were future employment, career opportunities, and intellectual challenge. Those aspiring to a career in surgery placed most emphasis on prestige, whilst an emphasis on lifestyle during training was associated with those choosing an alternative to surgery. Influences varied according to career stage.Conclusions: Future employment, career opportunities and intellectual challenge are most important when considering which discipline to choose within medicine, with job prestige of particular importance to those interested in a surgical career. These findings represent an opportunity for surgical educators to reinforce the positive aspects of life as a surgeon, and the job security which is inherent within a surgical career. Surgery remains a disproportionately unpopular choice for women, with lifestyle factors identified as the key deterrent. (C) 2009 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.