Factors associated with medical students' career choices regarding internal medicine

Karen E. Hauer, MD; Steven J. Durning, MD; Walter N. Kernan, MD; Mark J. Fagan, MD; Matthew Mintz, MD; Patricia S. O’Sullivan, EdD; Michael Battistone, MD; Thomas DeFer, MD; Michael Elnicki, MD; Heather Harrell, MD; Shalini Reddy, MD; Christy K. Boscardin, PhD; Mark D. Schwartz, MD

JAMA. 2008;300(10):1154-1164.

Context  Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine (IM) has declined (particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear.

Objectives  To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making.

Design, Setting, and Participants  Web-based cross-sectional survey of 1177 fourth-year medical students (82% response rate) at 11 US medical schools in spring 2007.

Main Outcome Measures  Demographics, debt, educational experiences, and number who chose or considered IM careers were measured. Factor analysis was performed to assess influences on career chosen. Logistic regression analysis was conducted to assess independent association of variables with IM career choice.

Results  Of 1177 respondents, 274 (23.2%) planned careers in IM, including 24 (2.0%) in general IM. Only 228 (19.4%) responded that their core IM clerkship made a career in general IM seem more attractive, whereas 574 (48.8%) responded that it made a career in subspecialty IM more attractive. Three factors influenced career choice regarding IM: educational experiences in IM, the nature of patient care in IM, and lifestyle. Students were more likely to pursue careers in IM if they were male (odds ratio [OR] 1.75; 95% confidence interval [CI], 1.20-2.56), were attending a private school (OR, 1.88; 95% CI, 1.26-2.83), were favorably impressed with their educational experience in IM (OR, 4.57; 95% CI, 3.01-6.93), reported favorable feelings about caring for IM patients (OR, 8.72; 95% CI, 6.03-12.62), or reported a favorable impression of internists' lifestyle (OR, 2.00; 95% CI, 1.39-2.87).

Conclusions  Medical students valued the teaching during IM clerkships but expressed serious reservations about IM as a career. Students who reported more favorable impressions of the patients cared for by internists, the IM practice environment, and internists' lifestyle were more likely to pursue a career in IM.