JAMA. 2008 Sep 10;300(10):1154-64.
Factors associated with medical students' career choices regarding internal medicine.
Hauer KE, Durning SJ, Kernan WN, Fagan MJ, Mintz M, O'Sullivan PS, Battistone M, DeFer T, Elnicki M, Harrell H, Reddy S, Boscardin CK, Schwartz MD.
Significance:
In a national survey of 1,177 senior students at eleven medical schools, Dr. Schwartz and colleagues found that only 24 (2%) planned careers in General internal Medicine, raising worries about a looming shortage of the primary care physicians who are the backbone of the American medical system.
Students who reported more favorable impressions of the patients cared for by internists, the practice environment, and internists' lifestyle were more likely to pursue a career in IM. To rebuild and sustain the US generalist physician workforce, improving students' experience of IM in medical school may no longer be sufficient. Bolder health marketplace reform will be required.
Abstract:
CONTEXT: Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine (IM) has declined (particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear.
OBJECTIVES: To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making.
DESIGN, SETTING, AND PARTICIPANTS: Web-based cross-sectional survey of 1177 fourth-year medical students (82% response rate) at 11 US medical schools in spring 2007.
MAIN OUTCOME MEASURES: Demographics, debt, educational experiences, and number who chose or considered IM careers were measured. Factor analysis was performed to assess influences on career chosen. Logistic regression analysis was conducted to assess independent association of variables with IM career choice.
RESULTS: Of 1177 respondents, 274 (23.2%) planned careers in IM, including 24 (2.0%) in general IM. Only 228 (19.4%) responded that their core IM clerkship made a career in general IM seem more attractive, whereas 574 (48.8%) responded that it made a career in subspecialty IM more attractive. Three factors influenced career choice regarding IM: educational experiences in IM, the nature of patient care in IM, and lifestyle. Students were more likely to pursue careers in IM if they were male (odds ratio [OR] 1.75; 95% confidence interval [CI], 1.20-2.56), were attending a private school (OR, 1.88; 95% CI, 1.26-2.83), were favorably impressed with their educational experience in IM (OR, 4.57; 95% CI, 3.01-6.93), reported favorable feelings about caring for IM patients (OR, 8.72; 95% CI, 6.03-12.62), or reported a favorable impression of internists' lifestyle (OR, 2.00; 95% CI, 1.39-2.87).
CONCLUSIONS: Medical students valued the teaching during IM clerkships but expressed serious reservations about IM as a career. Students who reported more favorable impressions of the patients cared for by internists, the IM practice environment, and internists' lifestyle were more likely to pursue a career in IM.
PMID: 18780844
