Characteristics of medical students by level of interest in family practice.

BACKGROUND AND OBJECTIVES: This study provides information on student factors associated with a career choice in family practice. METHODS: Information was used from multiple surveys completed by medical students, including the Premedical Questionnaire, the Matriculating Student Questionnaire, and the Graduation Questionnaire, as well as information from residency directors about residents in the Graduate Medical Education Tracking Census. These questionnaires are all a part of the Student and Applicant Information Management System of the Association of American Medical Colleges. Participants were 30,789 students graduating from US medical schools in 1991 and 1992. Comparisons were made between longitudinal student responses on the surveys to four types of outcomes. RESULTS: A total of 1,029 (3.3%) students were in the "Maintained" group (students who originally planned to enter family practice and were in a family practice residency at postgraduate year 1; 1,958 (6.4%) were "Gained" (originally chose a specialty other than family practice but entered a family practice residency); 1,950 (6.3%) were "Lost Interest" (originally identified family practice but entered another residency-two thirds of whom selected non-primary care specialties); 21,573 (70.1%) were "Never Interested" (did not express an early interest nor select a family practice residency); and the remainder (13.9%) had incomplete specialty data. Of those originally interested in family practice, 34.5% entered family practice residencies. Only 8.3% of those not originally interested entered family practice residencies. The four groups of students differed on many demographic, attitudinal, and experiential characteristics. Prestige, income, opportunities for research, and faculty status were more important to future specialists, while emphasis on primary care and prevention and practice in smaller communities were more important to the future family physicians. CONCLUSIONS: Medical schools could potentially increase the number of students selecting family practice residencies through both admissions policies and medical school experiences. These data provide some specifics on how to recruit students and prevent loss of those originally interested in family practice.

Effect of debt on U.S. medical school graduates' preferences for family medicine, general internal medicine, and general pediatrics.

The authors assess the importance of educational debt in graduates' primary care specialty choices, and the variety of mechanisms through which debt may influence career decisions. Logistic regression models were used to identify significant predictors of the primary care specialty choices made by the 1991 and 1992 graduates of U.S. medical schools. These predictors were debt itself; other financial indicators; certain medical school characteristics; certain practice location plans; certain demographic factors; aspects of academic performance; and students' predisposition to a primary care specialty. Data for this study were gathered from a variety of sources at the Association of American Medical Colleges and from the Health Education Assistance Loans program. Both direct and indirect effects of debt were identified under specific conditions. The study revealed complex relationships between debt and the other predictors identified. For example, debt operated in relation to the levels of the graduates' expected incomes; debt from subsidized loan sources was significant for women who chose general internal medicine; debt was important in choices of family practice; and debt by itself was significant for those planning to practice in the West and who chose general internal medicine. Also, seemingly opposing effects of debt occurred. For example, in the family practice model used in this study, the threshold effect of debt was positive, while the linear effect of debt above the threshold was negative. Such vriations help explain the conflicting findings of some past research. These and other findings prompt the authors to state that when investigating the effects of debt, it is not fruitful to ask what the effect of the debt is on all three primary care fields as a group. It is more appropriate to ask several questions, such as: under what conditions does debt influence specialty plans? Among which groups of students does debt have an impact on specialty plans? Are all of the primary care specialties similarly affected by the issues surrounding debt? Does the effect of debt change over time? The authors conclude by indicating possible policy implications of their findings.

Students who consider medicine but decide against it.

Changes in the medical student applicant pool during the 1980s prompted educators and researchers to question why students' interest in medicine may have shifted. The research presented here addresses the issue of why students may decide against careers in medicine. The authors report historical data from 1983 through 1988 on the number of individuals who expressed an interest in medicine when they took the Medical College Admission Test but failed to apply to medical school, and the results of two surveys sent to such individuals in 1986 and 1988 by the Association of American Medical Colleges. The findings indicate that the non-applicants are a stable and fairly large group (approximately 2,000 each year) and that they decide against medical careers because of financial concerns, discouragement from practicing physicians, and the ability of another field to satisfy their interest in science. These kinds of concerns, as well as some of the other reasons provided by non-applicants, can be changed and so have implications for admission and recruitment programs.

Racial-ethnic background and specialty choice: a study of U.S. medical school graduates in 1987.

This study used two Association of American Medical Colleges' questionnaires to determine whether there was a relationship between the racial-ethnic backgrounds and the specialty choices of a 1987 cohort of 11,136 U.S. medical school seniors, both prior to entering medical school and as they prepared for residency training. Their specialty preferences as premedical students were shown by their responses to the Premedical Student Questionnaire, administered when they registered for the Medical College Admission Test; their specialty choices at the end of their medical school training were shown by their responses to the Medical Student Graduation Questionnaire, which they completed shortly before graduation. Racial-ethnic backgrounds, self-recorded, were classified into black, other underrepresented minorities, Asian, other non-underrepresented minorities, and white. Specialties were clustered into primary care, medical specialties, surgical specialties, and supporting services. Before entering medical school, the students had similar specialty preferences regardless of background. As seniors in medical school, there was even greater convergence of specialty choices among the students of all backgrounds. Racial-ethnic background in itself appears not to have been a major factor influencing the senior medical students' specialty choices.