Researchers Ask First-year Medical Students: 'What's Important?'

It's no secret to family physicians that America's medical students too often pass over family medicine and other primary care specialties when choosing a medical career. As a result, some experts predict the country could experience a shortfall of as many as 45,000 primary care physicians by 2020.



Those facts may make the findings of a new research article titled "Primary Care, the ROAD Less Traveled: What First-Year Medical Students Want in a Specialty,(journals.lww.com)" all the more interesting to family physicians. The survey findings were published in the October issue of Academic Medicine.

Authors set out to discover how first-year medical students view and weigh lifestyle issues and specialty-selection characteristics. Researchers also wanted to know if first-year medical students' interest in primary care had any bearing on their ratings.

The 15-member investigative team examined survey responses from 1,020 first-year medical students who attended one of 11 medical degree-granting schools during the first four months of the 2012-13 academic year. Researchers intentionally chose a diverse national sample of schools.

STORY HIGHLIGHTS

• A recent study analyzes survey responses from first-year medical students attending 11 medical schools to find out what medical students want in a specialty.
  
• A full 61 percent of students, regardless of their interest in pursuing primary care, said enjoying their work was the most important factor in choosing a specialty.
  
• As students' self-reported interest in practicing primary care decreased, so did their perception of the importance of working with underserved patients and in rural areas.

Study Methods, Findings

Researchers surveyed the students and then analyzed the ratings they gave on the importance of five lifestyle domains and 21 medical specialty characteristics. The researchers used a 5-point Likert-type scale in which a ranking of 1 indicated "not important at all" and a ranking of 5 indicated "extremely important."

"When asked to rank the five domains of a good lifestyle, an overwhelming majority of first-year students in our study, regardless of interest in pursuing PC (primary care), selected 'enjoying the type of work I do' (61 percent) as the single most important domain," wrote the authors. Fifteen percent of respondents chose "having control of work schedule," 14 percent selected "having enough time off work," and 9 percent chose "enjoying the work environment" as the most important domain. Only 1 percent of students selected "financial compensation" as most important.

Researchers also asked respondents to rank 21 specialty-selection characteristics on a scale of 1 to 5. Students who listed primary care as their first choice of specialty assigned these characteristics the following rankings:

• time with family (4.6),
  
• work/life balance (4.6),
  
• personal time outside work (4.3),
  
• collegiality of co-workers (4.1),
  
• opportunities to work with underserved populations (3.8),
  
• average specialty salary (2.7),
  
• rural practice opportunities (2.4)
  
• research opportunities (2.3), and
  
• perceived prestige of the field (2.1).

By comparison, students who said they were least interested in primary care gave higher rankings in just three areas: average salary (3.6), research opportunities (2.8) and perceived prestige of the field (2.9).

"Although financial compensation was only moderately important to all first-year students, it was significantly less important to students selecting PC as their first choice" when compared with students who had either no opinion regarding pursuing a primary care specialty or who listed primary care as the specialty they were least likely to pursue, said the authors.

The authors reported that as students' self-reported interest in practicing primary care decreased, their perception of the importance of working with underserved populations and in rural areas dropped, as well. Furthermore, as interest in primary care waned, the importance of potential earnings increased.

"These findings support prior work showing that students matching into PC were influenced more by social compassion values than were students entering other specialties," said the authors.

Medical Student Turned Researcher

In an interview with AAFP News Now, corresponding study author Kimberly Clinite, a fourth-year medical student at the University of Chicago Pritzker School of Medicine, said that although she went into medical school with an open mind, she's now committed to pursuing family medicine.

Clinite also went in knowing more about the breadth and depth of the family medicine specialty than most of her classmates.

"My grandfather and father are family physicians in a very small town, so even though I knew what a robust family practice could be, I wasn't sure what my peers knew about it," said Clinite. "When primary care was talked about in lecture, I was really interested in how primary care and family medicine were being presented to my fellow classmates.

"In my clinical year -- regardless of primary care versus nonprimary care -- it was very interesting how students started talking about career selections," said Clinite. She called clinical rotations "a backstage pass to the hospital" and noted that even though they represented only small snippets of time in a medical student's career, "rotations strongly influenced students' perceptions of how medicine in different specialties and subspecialties was practiced."

"My classroom and clinical experiences made me want to continue my research that much more," said Clinite. "We need to make the training environment such that it won't (negatively) skew students' perceptions of primary care," she added.

Clinite currently is taking advantage of a Pritzker fellowship program that allows her to continue work for the next year on arms two and three of this ongoing research project. That timeline pushes her medical school graduation to 2015.

Continuing Research

The next arm of the study compares responses of first-year medical students to those of fourth-year students who graduated the same year that the new students entered medical school. In the third and final arm, researchers will again survey the original group of first-year students after they participate in the 2016 National Resident Matching Program.

In their closing discussion, study authors noted that following this group of students longitudinally "may help to clarify if and when preference values change during medical school."

Researchers pointed out that even though 57 percent of students who responded to the survey listed primary care as their first or second specialty choice, history shows that "only about half of the students who initially consider PC ultimately choose it, and that even fewer who do not initially consider PC ever switch into it."

"If medical school experiences dissuade students from entering PC, rethinking models of health care delivery and the practice of PC may be important for ensuring that it is enjoyable and sustainable for physicians," said the authors.

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