Predictors of Primary Care Practice Among Medical Students at the Michigan State University College of Human Medicine

Jennifer Edwards-Johnson; Youngjun Lee; Andrea Wendling; Baijiu Patel; Julie Phillips

doi:10.3122/jabfm.2022.02.210257

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Figure 1.
Proportions of students distributed among 4 groups based on their intention to practice primary care at matriculation and graduation (n = 430)
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Figure 2.
Percent of Michigan State University College of Human Medicine students practicing in each specialty that showed an interest in primary care (PCI) at matriculation but not graduation (Initial PCI group, n = 107).

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Table 1.

Coding Scheme Used to Indicate Primary Care Intention at Matriculation and Graduation, by Survey Year

Coding	Year	Variable Name	Questionnaire	Response Number
MSQ PCI = 1 (YES)	All	SPEC_PREF	“What general specialty are you considering?”	FM (180), IM (200), Peds (500)
GQ PCI = 1 (YES)	1978 to 1990	SPEC_PREF1	“If yes, which specialty are you planning?”	FM (06), IM (07), Peds (19)
	1978 to 1990	SUB_SPEC_PLAN	“Are you planning to become certified in a subspecialty?”	No
	1991 to 1998	SPEC_PREF1	“If yes, which specialty are you planning?”	FM (06), IM (07), Peds (19)
		SPEC_PLAN	“Are you planning to become certified in a specialty?”	Yes
		SUB_SPEC_PLAN	“Are you planning to become certified in a subspecialty?”	No
	1999 to 2004	SPEC_PREF1	“Which specialty are you planning?”	FM (06), IM (07), Peds (19)
	1999 to 2004	SPEC_PLAN	“Are you planning to become certified in a specialty?”	Yes
	2005 to 2010 (2008 was excluded)	SPEC_PREF	“Are you planning to become certified in a specialty or subspecialty? Choice of specialty/subspecialty”	FM (120), IM (140), Peds (320)
	2005 to 2010 (2008 was excluded)	SPEC_PLAN	“Are you planning to become certified in a specialty?”	Yes

Abbreviations: MSQ PCI, primary care intention at matriculation; GQ PCI, primary care intention at graduation; FM, Family Medicine; IM, Internal Medicine; Peds, Pediatrics. All other responses that were not indicated in this table were coded as 0.

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Table 2.

Descriptive Statistics and Response Rates of All MSU-CHM Students Graduating 1971–2010 (Original Cases) and the Subgroup of Those Students With Complete Responses to the Variables Used for This Study (Complete Cases) With Two-Sample Test for Equality of Proportions with Continuity Correction

Variables & Responses	Total Original Cases (N₁ = 2,047)			Complete Cases (N₂ = 430, 21%)			Response Rates (%)	(df)	P values
Variables & Responses	N₃	P	SD	N₂	P	SD	Response Rates (%)	(df)	P values
Gender Female	2,047 1,080	– 52%	– 0.50	430 222	– 52%	– 0.50	100.00	0.14 (1)	0.712
Race/ethnicity URM	2,040 350	– 17%	– 0.38	430 60	– 14%	– 0.35	99.66	2.41 (1)	0.121
Geographic origin Rural origin	1,903 595	– 31%	– 0.46	430 142	– 33%	– 0.47	92.97	0.42 (1)	0.515
Practice specialty PC	1,535 620	– 40%	– 0.49	430 197	– 46%	– 0.50	74.99	3.85 (1)	0.050
MSQ PCI Yes	961 550	– 57%	– 0.49	430 247	– 57%	– 0.50	46.95	0.00 (1)	0.988
GQ PCI Yes	1,059 431	– 41%	– 0.49	430 187	– 43%	– 0.50	51.73	0.87 (1)	0.351
Initial PCI Yes	560 136	– 24%	– 0.43	430 107	– 25%	– 0.43	27.36	0.02 (1)	0.887
Developed PCI Yes	560 67	– 12%	– 0.32	430 47	– 11%	– 0.31	27.36	0.16 (1)	0.686
Never PCI Yes	560 182	– 33%	– 0.47	430 136	– 32%	– 0.47	27.36	0.05 (1)	0.824
Always PCI Yes	560 175	– 31%	– 0.46	430 140	– 33%	– 0.47	27.36	0.14 (1)	0.712

Abbreviations: Total original cases (N₁ = 2,047), the number of samples making up the total sample size; Complete cases (N₂ = 430) = the number of cases with responses to all variables used for this analyses; N₃, the number of cases with responses to each variable (this number varies across the variables); P, proportions of each variable; SD, standard deviation of the proportion; Response rates, the number of people who completed the survey items divided by the number of people who make up the total sample size; , the χ² test for equality of proportions of each variables between N₃ and N₂ to evaluate the representativeness of the selected samples across variables; MSU-CHM, Michigan State University-College of Human Medicine; PC, primary care practice; Initial PCI, intention at matriculation-no intention at graduation; Developed PCI, no intention at matriculation-intention at graduation; Never PCI, no intention at matriculation-no intention at graduation; Always PCI, intention at matriculation-intention at graduation.

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Table 3.

Frequency and Proportion (%) of Primary Care Intention on Matriculating Student Questionnaire (MSQ) and Graduation Questionnaire (GQ) and Primary Care Practice, Across Demographic Variables With Chi-Square Test Results

DemographicCharacteristics	Frequency (n = 430)		Proportion (%)		(df)	P values
DemographicCharacteristics	MSQ PCI = 0	MSQ PCI = 1	MSQ PCI = 0	MSQ PCI = 1	MSQ PCI
Male	101	107	23.5%	24.9%	5.466 (1)	0.019
Female	82	140	19.1%	32.6%
Non-URM	156	214	36.3%	49.8%	0.074 (1)	0.786
URM	27	33	6.3%	7.7%
Nonrural origin	119	169	27.7%	39.3%	0.405 (1)	0.525
Rural origin	64	78	14.9%	18.1%
All students	183	247	42.6%	*57.3%*	-

	GQ PCI = 0	GQ PCI = 1	GQ PCI = 0	GQ PCI = 1	GQ PCI
Male	131	77	30.5%	17.9%	6.360 (1)	0.012
Female	112	110	26.0%	25.6%
Non-URM	203	167	47.2%	38.8%	2.465 (1)	0.116
URM	40	20	9.3%	4.7%
Nonrural origin	159	129	37.0%	30.0%	0.453 (1)	0.501
Rural origin	84	58	19.5%	13.5%
All students	243	187	*56.5%*	43.5%	-

	PC = 0	PC = 1	PC = 0	PC = 1	PC
Male	129	79	30.0%	18.4%	9.356 (1)	0.002
Female	104	118	24.2%	27.4%
Non-URM	200	170	46.5%	39.5%	0.000 (1)	1.000
URM	33	27	7.7%	6.3%
Nonrural origin	152	136	35.3%	31.6%	0.536 (1)	0.464
Rural origin	81	61	18.8%	14.2%
All students	233	197	54.2%	45.8%	-

Abbreviations: MSQ PCI, primary care intention at matriculation; GQ PCI, primary care intention at graduation; PC, primary care practice; 0, no, 1, yes.

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Table 4.

Logistic Regression Model Predicting Primary Care Practice

	Beta	SE	Wald	df	P values	Odds Ratio (95% CI)
Always PCI	4.606	0.431	10.691	1	< 0.001	100.08 (45.05–246.01)
Developed PCI	4.094	0.505	8.102	1	< 0.001	59.98 (23.47–172.00)
Initial PCI	1.355	0.404	3.357	1	< 0.001	3.88 (1.81–8.92)
Female	0.498	0.290	1.717	1	0.086	1.64 (0.93–2.92)
URM	0.627	0.401	1.566	1	0.117	1.87 (0.85–4.10)
Rural origin	−0.185	0.307	−0.601	1	0.548	0.83 (0.45–1.52)

Abbreviations: SE, standard error; Always PCI, intention at matriculation-intention at graduation; Developed PCI, intention at matriculation-intention at graduation; Initial PCI, intention at matriculation-no intention at graduation; URM, underrepresented minority; CI, confidence interval.

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Appendix.

Categorized Specialty Areas

Category	Specialties Included
Adult Medical Subspecialty	Cardiology, Infectious Disease, Sleep Medicine, Neurology, Interventional Cardiology, Nephrology, Allergy and Immunology, Gastroenterology, Hematology/Oncology, Rheumatology, Cardiac Electrophysiology, Neuromuscular Medicine
Adult Support Specialty	Anesthesiology, Radiology, Pathology, Radiation Oncology, Forensic Pathology, Physical Medicine & Rehabilitation, Pulmonary Medicine and Critical Care, Pain Management, Radiation Oncology, Interventional Radiology, Anatomic Pathology
Adult Surgical Subspecialty	Ophthalmology, Dermatology, Thoracic Surgery, Plastic Surgery, Neurosurgery, Otolaryngology, Orthopedic Surgery, Vascular Surgery, Cardiothoracic Surgery, Urology, Hand Surgery, Colorectal Surgery, Trauma Surgery, Breast Surgery, Surgical Critical Care
Pediatric Subspecialty	Pediatric Neurology, Pediatric Infectious Disease, Pediatric Cardiology, Pediatric Hematology/Oncology, Pediatric Endocrinology, Adolescent Medicine, Neonatology, Pediatric Physical Medicine and Rehabilitation, Pediatric Nephrology, Pediatric Rheumatology, Pediatric Gastroenterology
Pediatric Support Specialty	Pediatric Anesthesiology, Pediatric Pulmonology, Pediatric Critical Care, Pediatric Radiology
Pediatric Surgical Subspecialty	Pediatric Orthopedic Surgery
Other	Occupational Medicine, Integrative Medicine, Clinical Genetics, Addiction Medicine