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

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.

Effect of Anticipated Lifestyle and Income on Medical Students' Decision to Pursue a Primary Care Career in Saudi Arabia

Background: This study examines factors that influence Saudi Arabian medical school students in their selection of primary care as their career specialty. We focused on the two main factors identified to influence medical students generally in consideration of career specialty: lifestyle and income. We surveyed all fourth- and fifth-year students at 10 medical schools in the Riyad region using a questionnaire regarding factors influencing their intended specialty choice; 1005 (64%) completed the questionnaire. Results: The clear majority (77% of students) considered lifestyle characteristics to be a significant influence in their career decision to enter a specialty versus primary care (P<0.05). There was also significant relationship (p < 0.005) between students’ specialty choices and importance attached to anticipated income. Conclusion: Lifestyle and income consideration are important influences on specialty selection among 4th and 5th year Saudi Arabian medical students. These results are in consistent with findings of previous studies conducted in many nations around the world.

Building HIV Workforce Capacity Through a Residency Pathway: Outcomes and Challenges

To help address the impending HIV physician shortage, we launched an HIV Medicine Pathway within our Internal Medicine Residency in 2008. Between 2015 and 2017, surveys showed a decrease in the number of graduates providing primary care for people living with HIV. We suggest evaluation of long-term outcomes from similar training programs and stronger support for HIV primary care career development.