Factors Related to the Choice of Family Medicine: A Reassessment and Literature Review

Janet H. Senf; Doug Campos-Outcalt; Randa Kutob

doi:10.3122/jabfm.16.6.502

Article Figures & Data

Tables

View popup

Table 1.

Summary of Data

Topic	Bland et al9 (through 1993)	Meurer10 (through 1993)	Current study (through 2001)
Student Characteristics
Gender	Women more likely to enter primary care.		Inconsistent relationship between being female and choice of family practice.
Age	Older students more likely to enter family medicine.	Older students more likely to enter family medicine.	Older students more likely to enter family medicine.
Ethnicity	Mixed evidence that minority students enter primary care.	Minority status not related to primary care.	Hispanic students more likely to select family medicine.
Socioeconomic Status	Students with physician parents are less likely to select primary care.	Students with physician parents are less likely to select primary care.	Students whose parents had lower income or education more likely to select family medicine.
Marital Status	Married students more likely to plan a career in primary care.	Married students more likely to plan a career in primary care.	Not related.
Geographic Background	Rural background associated with choice of family practice.	Rural background associated with choice of family practice.	Rural background associated with choice of family practice.
Academic Background	Broad academic background related to primary care.	Behavioral science or liberal arts related to primary care.	No firm conclusions can be drawn.
Personality Type	Poor predictor of specialty choice.		No firm conclusions can be drawn.
Values and Knowledge on Entry to Medical School		Low income expectations related to choice of family practice.	Low income expectations and agreement that primary care physicians are more important than specialists related to choice of family practice. Contact with a particular specialty mentioned in a medical school application essay predicted choice of a “similar” specialty.
Career Intentions on Entry to Medical School	Primary care intentions disappear over the course of medical school.	Primary care intentions disappear over the course of medical school.	Preference on entry to medical school increased the likelihood of eventual choice of family practice, but for many students primary care intentions disappear over the course of medical school.
School Characteristics
Legislative Mandates			No firm conclusions can be drawn.
Type of School	Public ownership related to choice of family medicine.	Public ownership related to choice of family medicine.	Public ownership related to choice of family medicine.

Mission				Not directly related.
Departmental Structure	Department of family medicine related to higher numbers of primary care graduates.			Probably not directly related.
School Research Funding	Mixed results about the relationship of NIH funding to primary care.		NIH funding negatively related on univariate analysis, mixed results with multivariate analysis.	Probably not directly related.
Admission Policies	Unclear how they relate to specialty choice.			Probably not directly related.
Medical School Experiences
Special Programs	Longitudinal programs appear to increase number of primary care graduates.	“Most promising” results from programs with multiple supports for and experience with primary care.	Are related to specialty choice, but unclear what elements are important.	Are related to specialty choice, but unclear which elements are important.
Unofficial Climate for Primary Care				Negative comments related to changes in specialty choice for small percentages of students.
First- and Second-Year Curricula	No influence on specialty choice.	No influence on specialty choice.	No influence on specialty choice.	No influence on specialty choice
Third- and Fourth-Year Curricula and Experiences	Required time in the clinical years is positively related to choice of family medicine.	Required time in the clinical years is positively related to choice of family medicine.	Required time in the clinical years is positively related to choice of family medicine.	Required time in the clinical years is positively related to choice of family medicine.
Faculty Composition	Proportion of faculty who are family medicine is positively related to choice of family medicine.		Proportion of faculty who are family medicine is positively related to choice of family medicine.	Not directly related.
Faculty Role Models			Student selected interactions with faculty are positively related to choice of family medicine.	Having role models is related to specialty choice; negative role models cause a change away from family medicine.
Outcomes of Medical Education
Debt	No clear association.	Large debt or no debt is related to choice of a primary care specialty.		No clear association.
Knowledge of Content and Characteristics of Specialties				Perceptions of lack of prestige, low income potential and low intellectual content related to rejection of family medicine.
Career Intentions at Graduation	Specialty choice matched to career needs.			Low income expectations and intended rural/underserved practice related to choice of family practice. Interest in research or academic career negatively related.