The Role of Medical School Culture in Primary Care Career Choice

Abstract

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

Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study

“…specialty, which can elucidate the complex and interdependent contributions of these factors. 14 We sought to understand programmatic and contextual factors that influence career trajectories among primary care internal medicine residents, with a particular interest in potentially modifiable factors. Because little is known about which additional factors, particularly at the programmatic level, may be relevant to resident decision making, and because such factors may be complex and nuanced, we employed an exploratory approach through the use of qualitative methodology.…”

The Selling of Primary Care 2015

“…Student debt may have a modest effect on career choice, but the effect is complex 41,56,57 and other factors seem to be at least as important. 10,20,37,41,58-62 Women, older students, and students from rural areas are more likely to choose primary care careers, 10,36,57,63 but admission strategies selecting for these features have not been tested and there is some evidence to doubt they would succeed. 58 Thus, debt relief and admission management are of modest or uncertain value in influencing career choice.…”

“…36,37 Culture is heavily influenced by leadership, but perpetuated by mission statements, role models, and activities. Across the US, culture and experience converge so that students who matriculate with an interest in primary care tend to wander away during years of pre-doctoral training.…”

The Four Pillars for Primary Care Physician Workforce Reform: A Blueprint for Future Activity

“…These characteristics include applicants from a rural background, mature individuals with a broader life experience, students with lower income expectations or from lower socioeconomic backgrounds, and individuals with demonstrated evidence of an inclination toward public service and social consciousness. [6][7][8]10,13 Developing and admitting applicants who are most likely to pursue primary care practice is the first pillar. Sustaining their interest throughout medical education requires proactive positive mentoring including peer support, such as primary care student interest groups, exposure to high-functioning primary care practices, and contact with effective primary care physicians with good work-life balance.…”

“…Nevertheless, national statistics demonstrate that an insufficient number of students and residents are choosing primary care careers. [1][2][3][4][5] Family medicine organizations and researchers have identified factors that influence specialty choice including individual learner characteristics, training and practice environments, and payment systems, [6][7][8][9][10][11] and national debates continue the conversation about physician workforce. 12 This paper presents a framework with consistent language to guide our efforts to increase production of well-trained primary care physicians for our populations.…”