Pathways to Primary Care

The composition of the physician workforce has immediate implications for the quality of accessibility of healthcare services in the US, and there is a growing concern that both the number of physicians trained and the specialties that they choose will not satisfy the needs of society. The production of primary care physicians is particularly worrisome, and it is suspected the pre-residency environment engenders negative perceptions of primary care which contributes to this problem. The purpose of this dissertation was to inspect the differences between groups of students who indicated a primary care preference, a non-primary care preference, or were undecided at matriculation into and graduation from an LCME-accredited medical institution. Using data provided by the Association of American Medical Colleges (AAMC), 31,425 medical graduates who took the Post-MCAT Questionnaire (PMQ) between 2001 and 2006 provided data for these analyses. Using undecided students as the referent group in multinomial logistic regression models, we found that a student’s gender, pre-matriculation experience with science or medicine, and reasons for pursuing medicine as a career all strongly distinguished the three outcome groups. One’s prior specialty preference also strongly predicted their specialty preference at graduation. Analyzing the data through a socialization framework, it was concluded that experiences that allow students to “try on” the physician role are particularly powerful motivators. For institutions with a primary care focus, these data may help admission and recruiting teams identify the characteristics of students who are likely to enter and graduate with a primary care orientation. Alternatively, these findings may help institutions develop structures that will persuade students to consider a primary care specialty. Collectively, these strategies can be used to intentionally design medical student experiences so that students make optimal career decisions that satisfy the needs of society.