Graham Center to Launch Study on Student Career Choices, Debt Levels

The Josiah Macy Jr. Foundation has awarded a one-year, $195,000 grant to the AAFP's Robert Graham Center in Washington to study factors that influence a medical student's decision when choosing a certain field of practice and whether those factors affect a student's decision to work with underserved populations.

The evaluation will "look specifically at debt and a lot of other factors associated with student choice" of specialty, said Robert Phillips, M.D., M.P.H., director of the Graham Center. "We are going to pull together information about where people went to medical school, what they chose as their specialty and where they are working."

The Graham Center previously has studied individual factors that affect student career choices, but no one has taken a close look at how student debt affects those decisions, making this study unique, according to Phillips.

He noted that the study, which will be completed late next year, will gauge student debt at graduation and examine how that level of debt influences career decisions and how it affects students overall. "Everyone presumes debt is a strong factor, but no one knows how strong a factor it is," said Phillips.

The study also will look at whether medical students were exposed to primary care during their training and whether they worked with underserved populations to see if these experiences appear to have influenced their career paths. It will rely on Medicare data to determine if graduates are working in community health centers and will use data from the National Health Service Corps, or NHSC, to find out if graduates have ever worked in the NHSC. One of the study's data sets also will reveal the race of students, giving researchers an opportunity to determine if student race and background determine career paths.

The University of California, San Francisco; Dartmouth College, Hanover, N.H.; and New York University, New York, will help conduct the study, which also will gauge the effect of Title VII primary care training programs to determine whether those programs play a role in convincing students to choose a career in primary care. The study will look at whether Title VII reduces or mitigates student debt.

"There are two or three studies that now say Title VII is important, but we just don't know how important," Phillips said. "It may be that Title VII's effect is being swamped by debt. We just don't know."

Phillips suspects the study will show that Title VII is important. "I hope it will tell medical schools why primary care and underserved care experiences are important," Phillips said. "I hope it will tell policy-makers why Title VII matters. But we are prepared to learn that neither can overcome the effects of debt or the pull of much higher salaries."

According to Phillips, this study should give the AAFP more clarity about policy levers that affect student choice. "What should be (the AAFP's) lobbying, legislative priorities if we really want to move more students into primary care, and to help them to work with underserved populations?" asked Phillips.

The Macy Foundation grant represents a "new milestone" for the Graham Center, a recognition on the part of the foundation world that the Academy has a "health policy research center that is worth investing in and does good objective research," said Phillips.

"It really opens the doors for more work with other foundations whose research agendas line up well with the Academy's. The Macy Foundation has a rich legacy of supporting important physician research work, and we are grateful for its support."