The Role of Medical School Culture in Primary Care Career Choice

Erikson, Clese E. MPAff; Danish, Sana MPP; Jones, Karen C. MApStat; Sandberg, Shana F. PhD; Carle, Adam C. PhD

doi: 10.1097/ACM.0000000000000038
Research Reports

Purpose: To examine individual-level and medical-school-level factors, including the school’s primary care culture, that are associated with medical students’ likelihood of practicing primary care.

Method: In spring 2010, the Association of American Medical Colleges Center for Workforce Studies invited all fourth-year medical students at a stratified random sample of 20 U.S. MD-granting medical schools to participate in an online survey examining factors in specialty choice decisions. Schools were stratified according to the historical percentage of their graduates who became practicing primary care physicians. Multilevel logistic regression modeling was used to determine which individual- and school-level characteristics significantly predicted students’ likelihood of practicing primary care.

Results: Of the 2,604 students invited, 1,661 (64%) responded. Of the 1,554 students with complete data on variables of interest, 207 (13%) planned to enter a primary care residency and stated they were “very likely” to become a primary care physician on completion of training. Students who attended schools with high reported levels of “badmouthing” primary care were less likely to practice primary care (OR, 0.6; 95% CI, 0.4–0.9). Attending a school where students had greater than the median number of positive experiences in primary care clerkships increased the likelihood of practicing primary care (OR, 1.6; 95% CI, 1.1–2.3). Overall, 8% of the total variation in a student’s likelihood of practicing primary care was attributable to school-level factors.

Conclusions: Although individual students’ characteristics and preferences drive specialty choice decisions, the prevailing primary care culture at a school also plays a role.

Ms. Erikson is senior director, Center for Workforce Studies, Association of American Medical Colleges, Washington, DC.

Ms. Danish is an MBA student, University of Chicago Booth School of Business, Chicago, Illinois. At the time of writing, she was a data analyst, Center for Workforce Studies, Association of American Medical Colleges, Washington, DC.

Ms. Jones is senior data analyst, Center for Workforce Studies, Association of American Medical Colleges, Washington, DC.

Dr. Sandberg is research writer, Center for Workforce Studies, Association of American Medical Colleges, Washington, DC.

Dr. Carle is assistant professor of pediatrics, University of Cincinnati School of Medicine, and assistant professor of psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio.

Funding/Support: The Association of American Medical Colleges, the University of North Carolina Sheps Center for Health Services Research.

Other disclosures: None.

Ethical approval: The institutional review board of the American Institutes of Research approved this study (EX00175).

Previous presentation: Presented at the Association of American Medical Colleges Physician Workforce Research Conference; Washington, DC; May 3, 2012.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A164.

Correspondence should be addressed to Ms. Erikson, Association of American Medical Colleges, 2450 N St., NW, Washington, DC 20037; telephone: (202) 828-0587; e-mail: cerikson@aamc.org.

© 2013 by the Association of American Medical Colleges