Assessing factors for choosing a primary care specialty in medical students; A longitudinal study

• Published in: Medical education online Vol. 26; no. 1; p. 1890901
• Main Authors: McDonald, Corry, Henderson, Austin, Barlow, Patrick, Keith, Jerrod
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2021; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: College students; Debt; Gender; Longitudinal studies; Medical education; Medical schools; Medical students; Mentoring; mentorship; Pediatrics; Polls & surveys; Primary care; primary care; mentorship; Gender; medical education; debt
• ISSN: 1087-2981; 1087-2981
• DOI: 10.1080/10872981.2021.1890901

A shortage of primary care physicians exists in the US, and medical schools are investigating factors that influence specialty choice. To better understand the factors associated with medical students choosing primary care specialties, a longitudinal annual survey from 2013 to 2019 was administered to students at the University of Iowa Carver College of Medicine, starting pre-matriculation. A logistic regression model examined factors of interest. Matching into a primary care specialty (family medicine, internal medicine, pediatrics) for residency was the primary outcome. Our study compared factors students reported in annual surveys: demographics, mentorship, debt, and lifestyle. Factors significantly associated with primary care specialty included pre-medical and medical school research, a family member in primary care, student age and gender. 28% of men chose primary care, and 47% of women. Although there was no gender difference in rates of medical education debt (N = 286,χ2(1) = 0.28, p = 0.60), men were more likely to report being influenced by debt (N = 278, χ2(1) = 10.88, p = 0.001), and students who reported debt-influenced specialty choice were one-third as likely to enter primary care (N = 189, 95% CI [0.11-1.06], p = 0.06). For men, potential salary was negatively associated with entering primary care (p = 0.03). Women were more likely to have a mentor in primary care (N = 374, χ2(1) = 13.87, p < 0.001), but this was not associated with an increased likelihood of entering primary care for men or women. Having a family member who practices primary care was associated with a 2.87 times likelihood of entering primary care (N = 303, 95% CI [1.14-7.19], p = 0.03). The decision to enter primary care is influenced by many factors; a key gender differentiator is that men's specialty choice is more negatively influenced by financial concerns.