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Purpose: The number of applicants to general surgery programs has recently declined. We set out to determine factors that influence career choice among medical students., Design: survey;, Setting: university medical center;, Participants: fourth-year medical students;, Intervention: distribution and completion of the survey. PARTICIPANTS ranked 18 items coded on a Likert scale from 1 (not important) to 8 (very important). These factors were career opportunities, academic opportunities, experience on core rotation/subinternship, role model(s) in that specialty (mentors), length of training required, lifestyle during residency, work hours during residency, ability to obtain residency position, concern about loans/debt, call schedule, lifestyle after training, work hours after training, financial rewards after training, intellectual challenge, patient relationships/interaction, prestige, future patient demographics, and gender distribution in the specialty. Students were asked to provide gender, career choice, number of programs they applied to, and the number of programs at which they were interviewed., Results: A total of 111 of the 160 surveys distributed were returned (69%). A total of 48 of the students were men, 31 were women, and 32 did not identify their gender. Nineteen students were interested in pursuing a career in surgery or a surgical subspecialty. Factors predicting surgery as a career choice were career opportunities (p < 0.04) and prestige (p < 0.003). Lifestyle during residency (p < 0.0007), work hours during residency (p < 0.008), and quality of patient/physician relationships (p < 0.05) were all significantly negatively correlated with the choice of a surgical career. Students pursuing a surgical career applied to greater than 31 programs compared with 11 to 15 for the nonsurgical students (p < 0.0001)., Conclusions: Prestige and career opportunities are more important to students seeking surgical residencies. Concerns about lifestyle and work hours during residency and perceived quality of patient/physician relationships were deterrents to surgery as a career choice. These issues may need to be addressed to increase the number of applicants to surgical programs.