Association of Demographic Factors and Medical School Experiences With Students’ Intention to Pursue a Surgical Specialty and Practice in Underserved Areas

Abstract

IMPORTANCEThe surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students' intention to practice in underserved areas is unknown.OBJECTIVE To evaluate the association between students' demographics and medical school experiences with intention to pursue surgery and practice in underserved areas. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020.MAIN OUTCOMES AND MEASURES Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students' intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas. RESULTS Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ 2 P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas.CONCLUSIONS AND RELEVANCE This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students' motivation to practice in underserved areas.

Association Between Racial and Ethnic Diversity in Medical Specialties and Residency Application Rates

“…In addition, among those interested in surgical specialties, racial and ethnic minority medical students are more likely to report an intent to practice in underserved areas. 7 When asked in 2020, most medical students reported that fit with personality, interest, and skill strongly influenced their specialty choice. 8 More than one-half of respondents cited role model influences as a vital factor in this choice.…”

“…In addition, among those interested in surgical specialties, racial and ethnic minority medical students are more likely to report an intent to practice in underserved areas. 7 …”

“…Racial and ethnic diversity at the specialty level is essential because it may shape access to health care among underserved communities; racial and ethnic minority medical students have reported greater intent to practice in underserved settings, and there is a skew in their representation across specialties, favoring primary care specialties. In addition, among those interested in surgical specialties, racial and ethnic minority medical students are more likely to report an intent to practice in underserved areas …”

Demographic Factors and Medical School Experiences Associated with Students' Intention to Pursue Orthopaedic Surgery and Practice in Underserved Areas

“…In this study, we provide evidence of another potential benefit of ethnoracial and sex diversity in orthopaedic surgery: intention to practice in underserved areas. Previous studies have explored the characteristics of medical students interested in working with underserved populations 3 , 11 , 12 ; this study uses national data to investigate the characteristics of students who intend to pursue orthopaedic surgery with respect to intent to practice in an underserved area. Those who identified as women, ethnoracial URMs, and first-generation college graduates comprised a significantly lower percentage of students pursuing orthopaedic surgery than all other specialties.…”

Individuals' Awareness of and Willingness to Accept Hospital-at-Home Services and Related Factors: A Cross-Sectional Study

“…The findings of this study indicate that compared to the awareness of HaH services, there was a greater willingness to accept HaH care among the subjects. Because of the shortage of medical resources in recent years, healthcare professionals cannot provide adequate medical services to every patient, which results in patients' needs not being fully met and leads to poor healthcare experiences (20,21). In addition, the unfamiliarity of the hospital environment can harm patients' mental health, which is not conducive to their recovery (22).…”