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Variation in predictors of primary care career choice by year and stage of training

A national survey

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Abstract

CONTEXT: It is not known whether factors associated with primary care career choice affect trainees differently at different times or stages of medical education.

OBJECTIVE: To examine how role models, encouragement, and personal characteristics affect career choice at different stages (medical school vs residency) and periods (1994 vs 1997) of training.

DESIGN: A split-panel design with 2 cross-sectional telephone surveys and a panel survey in 1994 and 1997.

PARTICIPANTS: A national probability sample of fourth-year students (307 in 1994, 219 in 1997), 645 second-year residents in 1994, and 494 third-year residents in 1997. Of the fourth-year students interviewed in 1994, 241 (78.5%) were reinterviewed as third-year residents in 1997.

MAIN OUTCOME MEASURE: Primary care (general internal medicine, general pediatrics, or family medicine) career choice.

RESULTS: Having a primary care role model was a stronger predictor of primary care career choice for residents (odds ratio [OR], 18.0; 95% confidence interval [95% CI], 11.2 to 28.8 in 1994; OR, 43.7; 95% CI, 24.4 to 78.3 in 1997) than for students (OR, 6.5; 95% CI, 4.3 to 10.2; no variation by year). Likewise, peer encouragement was more predictive for residents (OR, 5.4; 95% CI, 3.3 to 8.9 in 1994; OR, 16.6; 95% CI; 9.7 to 28.4 in 1997) than for students (OR, 2.1; 95% CI, 1.3 to 3.2; no variation by year). Orientation to the emotional aspects of care was consistently associated with primary care career choice across stages and years of training.

CONCLUSIONS: The effect of peer encouragement and role models on career choice differed for students and residents and, in the case of residents, by year of training, suggesting that interventions to increase the primary care workforce should be tailored to stage of training.

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References

  1. Babbott D, Baldwin DC Jr, Killian CD, O’Leary Weaver S. Trends in evolution of specialty choice. Comparison of US medical school graduates in 1983 and 1987. JAMA. 1989;261:2367–73.

    Article  PubMed  CAS  Google Scholar 

  2. Shea JA, Kletke PR, Wozniak GD, Polsky D, Escarce JJ. Self-reported physician specialities and the primary care content of medical practice. A study of the AMA physician masterfile. Med Care. 1999;37:333–8.

    Article  PubMed  CAS  Google Scholar 

  3. Christakis NA, Jacobs JA, Messikomer CM. Change in self-definition from specialist to generalist in a national sample of physicians. Ann Intern Med. 1994;121:669–75.

    PubMed  CAS  Google Scholar 

  4. Bertram DA. Specialty changes made by young physicians from graduate training to practice. Med Care. 1993;31:533–41.

    Article  PubMed  CAS  Google Scholar 

  5. Rabinowitz HK. The change in specialty preference by medical students over time: an analysis of students who prefer family medicine. Fam Med. 1990;22:62–3.

    PubMed  CAS  Google Scholar 

  6. Rabinowitz HK, Gang X, Robeson MR, et al. Generalist career plans: tracking medical school seniors through residency. Acad Med. 1997;72:S103–5.

    Article  PubMed  CAS  Google Scholar 

  7. Grumbach K, Becker SH, Osborn EHS, Bindman AB. The challenge of defining and counting generalist physicians: an analysis of physician masterfile data. Am J Public Health. 1995;85:1402–7.

    Article  PubMed  CAS  Google Scholar 

  8. Hensel WA. Calculating the number of new generalist physicians. [letter]. Acad Med. 1993;68:498.

    Article  PubMed  CAS  Google Scholar 

  9. Martini CJM, Veloski JJ, Barzansky B, Xu G, Fields SK. Medical school and student characteristics that influence choosing a generalist career. JAMA. 1994;272:661–8.

    Article  PubMed  CAS  Google Scholar 

  10. Funkenstein DH. Medical Students, Medical Schools and Society During Five Eras: Factors Affecting the Career Choices of Physicians 1958–1976. Cambridge, Mass: Ballinger Publishing Company; 1978.

    Google Scholar 

  11. Association of American Medical Colleges. AAMC Data Book: Statistical Information Related to Medical Schools and Teaching Hospitals. Washington, DC: Association of American Medical Colleges; 2000.

    Google Scholar 

  12. Menard S. Longitudinal Research. 2nd ed. London: Sage Publications, Inc.; 2002.

    Google Scholar 

  13. Campos-Outcalt D, Senf J, Watkins AJ, Bastacky S. The effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician careers: a review and quality assessment of the literature. Acad Med. 1995;70:611–9.

    Article  PubMed  CAS  Google Scholar 

  14. Henderson MC, Hunt DK, Williams JW Jr. General internists influence students to choose primary care careers: the power of role modeling. Am J Med. 1996;101:648–53.

    Article  PubMed  CAS  Google Scholar 

  15. Wright S, Wong A, Newill C. The impact of role models on medical students. J Gen Intern Med. 1997;12:53–6.

    Article  PubMed  CAS  Google Scholar 

  16. Burack JH, Irby DM, Carline JD, Ambrozy DA, Ellsbury KE, Stritter FT. A study of medical students’ specialty-choice pathways: trying on possible selves. Acad Med. 1997;72:534–41.

    Article  PubMed  CAS  Google Scholar 

  17. Hunt DD, Scott C, Zhong S, Goldstein E. Frequency and effect of negative comments (badmouthing) on medical students’ career choices. Acad Med. 1996;71:665–9.

    Article  PubMed  CAS  Google Scholar 

  18. Ambrozy DA, Irby DM, Bowen JL, Burack JH, Carline JD, Stritter FT. Role models’ perceptions of themselves and their influence on students’ specialty choice. Acad Med. 1997;72:1119–21.

    Article  PubMed  CAS  Google Scholar 

  19. Bland CJ, Meurer LN, Maldonado G. Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. Acad Med. 1995;70:620–41.

    Article  PubMed  CAS  Google Scholar 

  20. Carr P, Noble J, Friedman RH, Starfield B, Black C. Choices of training programs and career paths of women in internal medicine. Acad Med. 1993;68:219–23.

    Article  PubMed  CAS  Google Scholar 

  21. McMurray JE, Schwartz MD, Genero NP, Linzer M, for the Society of General Internal Medicine Task Force on Career Choice in Internal Medicine. The attractiveness of internal medicine: a qualitative analysis of the experiences of female and male medical students. Ann Intern Med. 1993;119:812–6.

    PubMed  CAS  Google Scholar 

  22. Lieu TA, Schroeder SA, Altman DF. Specialty choices at one medical school: recent trends and analysis of predictive factors. Acad Med. 1989;64:622–9.

    Article  PubMed  CAS  Google Scholar 

  23. Noble J, Friedman RH, Starfield B, Ash A, Black C. Career differences between primary care and traditional trainees in internal medicine and pediatrics. Ann Intern Med. 1992;116:482–7.

    PubMed  CAS  Google Scholar 

  24. Brotherton SE. The relationship of indebtedness, race, and gender to the choice of general or subspecialty pediatrics. Acad Med. 1995;70:149–51.

    Article  PubMed  CAS  Google Scholar 

  25. Elks ML. Gender issues and generalism in medicine. Acad Med. 1996;71:1281–4.

    Article  PubMed  CAS  Google Scholar 

  26. Xu G, Rattner SL, Veloski JJ, Hojat M, Fields SK, Barzansky B. A national study of the factors influencing men and women physicians’ choices of primary care specialties. Acad Med. 1995;70:398–404.

    Article  PubMed  CAS  Google Scholar 

  27. Lyttle CS, Levey GS. The National Study of Internal Medicine Manpower: XX. The changing demographics of internal medicine residency training programs. Ann Intern Med. 1994;121:435–41.

    PubMed  CAS  Google Scholar 

  28. Xu G, Veloski JJ, Barzansky B. Comparisons between older and usual-aged medical school graduates on the factors influencing their choices of primary care specialists. Acad Med. 1997;72:1003–7.

    Article  PubMed  CAS  Google Scholar 

  29. Haynes RA, Killian CD. Practice Patterns of Young Physicians: Outcomes of Graduates’ Plans in Three Areas—Primary Care, Geographic Location, and Socio-Economically Deprived Areas. A Final Report. Washington, DC: Association of American Medical Colleges; 1990.

    Google Scholar 

  30. Thurmond VB, Cregler LL. Specialty choices and practice locales of black graduates from a predominantly white medical school. Acad Med. 1993;68:929–30.

    Article  PubMed  CAS  Google Scholar 

  31. Rabinowitz HK. Relationship between US medical school admission policy and graduates entering family practice. Fam Pract. 1988;5:142–4.

    Article  PubMed  CAS  Google Scholar 

  32. Rabinowitz HK. Recruitment, retention, and follow-up of graduates of a program to increase the number of family physicians in rural and underserved areas. N Engl J Med. 1993;328:934–99.

    Article  PubMed  CAS  Google Scholar 

  33. Gorenflo DW, Ruffin MT, Sheets KJ. A multivariate model for specialty choice by medical students. J Fam Pract. 1994;39:570–6.

    PubMed  CAS  Google Scholar 

  34. Senf JH, Campos-Outcalt D, Watkins AJ, Bastacky S, Killian C. A systematic analysis of how medical school characteristics relate to graduates’ choices of primary care specialties. Acad Med. 1997;72:524–33.

    Article  PubMed  CAS  Google Scholar 

  35. Bickel J, Ruffin A. Gender-associated differences in matriculating and graduating medical students. Acad Med. 1995;70:551–9.

    Article  Google Scholar 

  36. Lee EU, Forthofer RN, Lorimer RJ. Analyzing Complex Survey Data. Quantitative Applications in the Social Sciences, No. 71. Thousand Oaks, Calif: Sage Publications; 1989.

    Google Scholar 

  37. Firebaugh G. Analyzing Repeated Surveys: Quantitative Applications in the Social Sciences. Thousand Oaks, Calif: Sage Publications; 1997.

    Google Scholar 

  38. Long JS. Regression Models for Categorical and Limited Dependent Variables. Advanced Quantitative Techniques in the Social Sciences, #7. Thousand Oaks, Calif: Sage Publications; 1997.

    Google Scholar 

  39. Clogg CC, Shihadeh ES, Statistical Models for Ordinal Variables. Advanced Quantitative Techniques in the Social Sciences, #4. Thousand Oaks, CA: Sage Publications, 1994.

    Google Scholar 

  40. McCullagh P. Generalized Linear Models. 2nd ed. London: Chapman Hall; 1989.

    Google Scholar 

  41. Sullivan AM. Connections of Promise: Women in the Lives of Adolescent Girls. Doctoral dissertation. Cambridge, Mass: Harvard University; 1997.

    Google Scholar 

  42. Taylor JM, Gilligan C, Sullivan AM, Between Voice and Silence. Women and Girls, Race and Relationship. Cambridge: Harvard University Press; 1995.

    Google Scholar 

  43. Galbo J. The teacher as significant adult: a review of the literature. Adolescence. 1995;24:549–56.

    Google Scholar 

  44. Friedman CP, Slatt LM. New results relating the Myers-Briggs type indicator and medical specialty choice. J Med Educ. 1988;63:325–7.

    PubMed  CAS  Google Scholar 

  45. Couts-van Dijk LC, Bray JH, Moore S, Rogers J. Prospective study of how students’ humanism and psychosocial beliefs relate to specialty match. Acad Med. 1997;72:1106–8.

    Article  Google Scholar 

  46. Kassebaum D, Szenas P. Factors influencing the specialty choice of 1993 medical school graduates. Acad Med. 1994;69:164–70.

    Google Scholar 

  47. Fincher RE, Lewis LA. Influences on specialty choice: are they different for switchers and non-switchers? Acad Med. 1999;74:S121–3.

    Article  PubMed  CAS  Google Scholar 

  48. Calkins EV, Willoughby TL, Arnold LM. Gender and psychosocial factors associated with specialty choice. JAMA. 1987;42:170–2.

    CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. the Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn

    Nina Martin EdD

  2. the Harvard Graduate School of Education, Cambridge, Mass

    Judith D. Singer PhD

  3. the Division of Psychiatry, Brigham and Women’s Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Mass

    Amy M. Sullivan EdD & Susan D. Block MD

  4. Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave., 6th Floor, 02215, Boston, MA

    Maureen T. Connelly MD, MPH, Antoinette S. Peters PhD, Nancy Clark-Chiarelli EdD, Natasha Zotov EdM & Steven R. Simon MD, MPH

Authors
  1. Maureen T. Connelly MD, MPH
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  2. Amy M. Sullivan EdD
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  3. Antoinette S. Peters PhD
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  4. Nancy Clark-Chiarelli EdD
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  5. Natasha Zotov EdM
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  6. Nina Martin EdD
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  7. Steven R. Simon MD, MPH
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Corresponding author

Correspondence to Maureen T. Connelly MD, MPH.

Additional information

Funding was provided by the Robert Wood Johnson Foundation (grants 20091 and 21608).

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Connelly, M.T., Sullivan, A.M., Peters, A.S. et al. Variation in predictors of primary care career choice by year and stage of training. J GEN INTERN MED 18, 159–169 (2003). https://doi.org/10.1046/j.1525-1497.2003.01208.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.01208.x

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