Variation in Predictors of Primary Care Career Choice by Year and Stage of Training

A National Survey

Authors

  • Maureen T. Connelly MD, MPH,

    Corresponding author
    1. Received from the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (MTC, ASP, NCC, NZ, SRS), Boston, Mass; the Department of Psychology and Human Development, Vanderbilt University (NM), Nashville, Tenn; the Harvard Graduate School of Education (JDS), Cambridge, Mass; and the Division of Psychiatry, Brigham and Women's Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute (SDB, AMS), Boston, Mass.
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  • Amy M. Sullivan EdD,

    1. Received from the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (MTC, ASP, NCC, NZ, SRS), Boston, Mass; the Department of Psychology and Human Development, Vanderbilt University (NM), Nashville, Tenn; the Harvard Graduate School of Education (JDS), Cambridge, Mass; and the Division of Psychiatry, Brigham and Women's Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute (SDB, AMS), Boston, Mass.
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  • Antoinette S. Peters PhD,

    1. Received from the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (MTC, ASP, NCC, NZ, SRS), Boston, Mass; the Department of Psychology and Human Development, Vanderbilt University (NM), Nashville, Tenn; the Harvard Graduate School of Education (JDS), Cambridge, Mass; and the Division of Psychiatry, Brigham and Women's Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute (SDB, AMS), Boston, Mass.
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  • Nancy Clark-Chiarelli EdD,

    1. Received from the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (MTC, ASP, NCC, NZ, SRS), Boston, Mass; the Department of Psychology and Human Development, Vanderbilt University (NM), Nashville, Tenn; the Harvard Graduate School of Education (JDS), Cambridge, Mass; and the Division of Psychiatry, Brigham and Women's Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute (SDB, AMS), Boston, Mass.
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  • Natasha Zotov EdM,

    1. Received from the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (MTC, ASP, NCC, NZ, SRS), Boston, Mass; the Department of Psychology and Human Development, Vanderbilt University (NM), Nashville, Tenn; the Harvard Graduate School of Education (JDS), Cambridge, Mass; and the Division of Psychiatry, Brigham and Women's Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute (SDB, AMS), Boston, Mass.
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  • Nina Martin EdD,

    1. Received from the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (MTC, ASP, NCC, NZ, SRS), Boston, Mass; the Department of Psychology and Human Development, Vanderbilt University (NM), Nashville, Tenn; the Harvard Graduate School of Education (JDS), Cambridge, Mass; and the Division of Psychiatry, Brigham and Women's Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute (SDB, AMS), Boston, Mass.
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  • Steven R. Simon MD, MPH,

    1. Received from the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (MTC, ASP, NCC, NZ, SRS), Boston, Mass; the Department of Psychology and Human Development, Vanderbilt University (NM), Nashville, Tenn; the Harvard Graduate School of Education (JDS), Cambridge, Mass; and the Division of Psychiatry, Brigham and Women's Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute (SDB, AMS), Boston, Mass.
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  • Judith D. Singer PhD,

    1. Received from the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (MTC, ASP, NCC, NZ, SRS), Boston, Mass; the Department of Psychology and Human Development, Vanderbilt University (NM), Nashville, Tenn; the Harvard Graduate School of Education (JDS), Cambridge, Mass; and the Division of Psychiatry, Brigham and Women's Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute (SDB, AMS), Boston, Mass.
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  • Susan D. Block MD

    1. Received from the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (MTC, ASP, NCC, NZ, SRS), Boston, Mass; the Department of Psychology and Human Development, Vanderbilt University (NM), Nashville, Tenn; the Harvard Graduate School of Education (JDS), Cambridge, Mass; and the Division of Psychiatry, Brigham and Women's Hospital and Adult Psychosocial Oncology, Dana-Farber Cancer Institute (SDB, AMS), Boston, Mass.
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Address correspondence and requests for reprints to Dr. Connelly: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave., 6th Floor, Boston, MA 02215 (e-mail: maureen_connelly@hphc.org).

Abstract

CONTEXT: It is not known whether factors associated with primary care career choice affect trainees differently at different times or stages of medical education.

OBJECTIVE: To examine how role models, encouragement, and personal characteristics affect career choice at different stages (medical school vs residency) and periods (1994 vs 1997) of training.

DESIGN: A split-panel design with 2 cross-sectional telephone surveys and a panel survey in 1994 and 1997.

PARTICIPANTS: A national probability sample of fourth-year students (307 in 1994, 219 in 1997), 645 second-year residents in 1994, and 494 third-year residents in 1997. Of the fourth-year students interviewed in 1994, 241 (78.5%) were re-interviewed as third-year residents in 1997.

MAIN OUTCOME MEASURE: Primary care (general internal medicine, general pediatrics, or family medicine) career choice.

RESULTS: Having a primary care role model was a stronger predictor of primary care career choice for residents (odds ratio [OR], 18.0; 95% confidence interval [95% CI], 11.2 to 28.8 in 1994; OR, 43.7; 95% CI, 24.4 to 78.3 in 1997) than for students (OR, 6.5; 95% CI, 4.3 to 10.2; no variation by year). Likewise, peer encouragement was more predictive for residents (OR, 5.4; 95% CI, 3.3 to 8.9 in 1994; OR, 16.6; 95% CI; 9 .7 to 28.4 in 1997) than for students (OR, 2.1; 95% CI, 1.3 to 3.2; no variation by year). Orientation to the emotional aspects of care was consistently associated with primary care career choice across stages and years of training.

CONCLUSIONS: The effect of peer encouragement and role models on career choice differed for students and residents and, in the case of residents, by year of training, suggesting that interventions to increase the primary care workforce should be tailored to stage of training.

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