Students’ intentions to practice primary care are associated with their motives to become doctors: a longitudinal study

Abstract

Background Medical schools can contribute to the insufficient primary care physician workforce by influencing students’ career preferences. Primary care career choice evolves between matriculation and graduation and is influenced by several individual and contextual factors. This study explored the longitudinal dynamics of primary care career intentions and the association of students’ motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period. Methods The sample consisted of medical students from two classes recruited into a cohort study during their first academic year, and who completed a yearly survey over a four-year period from their third (end of pre-clinical curriculum) to their sixth (before graduation) academic year. Main outcome measures were students’ motives for becoming doctors (ten motives rated on a 6-point scale) and career intentions (categorized into primary care, non-primary care, and undecided). Population-level flows of career intentions were investigated descriptively. Changes in the rating of motives over time were analyzed using Wilcoxon tests. Two generalized linear mixed models were used to estimate which motives were associated with primary care career intentions. Results The sample included 217 students (60% females). Career intentions mainly evolved during clinical training, with smaller changes at the end of pre-clinical training. The proportion of students intending to practice primary care increased over time from 12.8% (year 3) to 24% (year 6). Caring for patients was the most highly rated motive for becoming a doctor. The importance of the motives cure diseases, saving lives, and vocation decreased over time. Primary care career intentions were positively associated with the motives altruism and private practice, and negatively associated with the motives prestige, academic interest and cure diseases. Conclusion Our study indicates that career intentions are not fixed and change mainly during clinical training, supporting the influence of clinical experiences on career-related choices. The impact of students’ motives on primary care career choice suggests strategies to increase the attractivity of this career, such as reinforcing students’ altruistic values and increasing the academic recognition of primary care.

The formation of physician altruism

“…Fourth, the link between medical students' patient-regarding altruism and their occupational choices is important as it may also explain some of the key occupational choices by future physicians (e.g., Pfarrwaller et al, 2022). For example, our results can also inform the ongoing policy debate about the trends and determinants of physician shortages.…”

Millennials Medical Students Generation at the Crosswalks: Motivations and Attitudes Towards Study and Future Career – A Mixed-Method Study

“… 57 This tendency increased in graduate level or with higher semester level. 58 Male and female students expressed similar attitudes regarding the preferred work setting (GP, specialization), although the first favor hospital work at the beginning of their medical training more than the latter, the majority of all students aim for a private practice because of presumed flexible working hours as a GP. Curriculum or semester level had no influence on this attitude.…”

“…e) This study was carried out solely in Germany and as such not necessarily mirroring students’ perceptions in other countries or regions, although the comparison with comparable studies done in other developed countries revealed, depending on subthemes of professionalism, similar results. 58 , 67 …”

Dynamics of career intentions in a medical student cohort: a four-year longitudinal study

“…Few studies analyzed career intentions longitudinally using more than two time points. We recently described career intention dynamics in a four-year cohort with a focus on primary care, observing that changes predominated in early clinical years [ 20 ]. However, this analysis could not conclude on the stability of individual career intentions.…”