March 05, 2019 08:24 am Michael Devitt – Since its inception in 2013, Family Medicine for America's Health (FMAHealth) has made increasing the number of medical students who choose family medicine one of its top priorities. With that goal in mind, a group of resident and medical student leaders involved in FMAHealth spearheaded a study, published in the February issue of Family Medicine, to uncover new insights into the factors that influence student choice of family medicine and to quantify the differences between medical schools that graduate more versus those that produce fewer family physicians.
The study's authors represented the Student and Resident Collaborative working on behalf of the FMAHealth Workforce Education & Development Tactic Team, the group responsible for garnering support from the eight family medicine organizations for what is now the America Needs More Family Doctors: 25 x 2030 collaborative. The goal of the 25 x 2030 collaborative is to increase the proportion of U.S. medical graduates entering family medicine residencies from the current 12.6 percent to 25 percent by the year 2030.
For the study, the workforce team interviewed fourth-year medical students from the 10 U.S. allopathic medical schools with the highest percentage of students entering family medicine residencies -- the so-called top 10 -- as well as students from other allopathic medical schools in the United States. Students participated in 90-minute virtual focus group discussions moderated by a workforce team leader. In the sessions, students were asked a series of open-ended questions to identify the factors that led them to choose a particular specialty.
During a two-year period, the workforce team interviewed 55 medical students from 19 allopathic medical schools across the country. Thirty-seven of those students were applying to family medicine, and 34 students were at top 10 institutions.
Notably, participating students from top 10 schools held family physicians in high esteem, regardless of the specialty to which they applied. Overall, students did not reference physician compensation as a driving factor when discussing what led to their specialty choice.
Of three key factors referenced across all focus groups as reasons for choosing family medicine, the first was the presence of high-quality family medicine preceptors who were openly enthusiastic about the specialty and who practiced full-scope family medicine. Providing that kind of exposure gave students an idea of the breadth of the specialty and offered them a window into what the typical family physician could expect to encounter in practice.
The second factor was the value of a rural family medicine experience, which was linked to the specialty's broad scope of practice.
The third factor was top-down institutional support for primary care in general, and family medicine in particular. Many participants pointed to the integration of family medicine faculty members into the preclinical curriculum as an example of such support.
Compared with students at non-top 10 schools, students at top 10 schools were more likely to understand the full scope of practice of family medicine and to report a stronger culture around the specialty, including explicit support for family medicine at their institutions. Students at these schools specifically highlighted the discrepancies between urban versus rural family physician scope of practice and were less likely to pursue family medicine if they planned to practice in an urban setting.
Students at non-top 10 institutions, on the other hand, reported that family medicine was underappreciated. They noted there was less exposure to family medicine and more institutional stigma against the specialty. They also more often mentioned specific factors such as public health, social justice and advocacy as motivation to choose family medicine. Finally, students at non-top 10 schools were more likely to perceive family medicine's scope as limited to outpatient chronic disease management.
Among students from either group of medical schools who did not choose family medicine, three factors were consistently noted: administrative burden, a preference for a more limited scope of practice and underappreciation of family physicians.
The authors concluded that many factors influence a medical student's decision to choose family medicine as their specialty. These factors varied not only between schools with the highest percentages of students who matched into family medicine and those with lower match percentages, but among individual schools in both groups. Addressing these factors, they wrote, will be crucial to increasing the number of students who choose family medicine in the coming years and, thus, reducing the shortage of primary care physicians.
"This study reflects the complexity and variability of specialty and career choice and the need to influence change across the continuum of education and practice," said AAFP student interest strategist Ashley Bentley, M.B.A. "To achieve the optimal family medicine workforce, we're going to have to impact change at every level.
"The results of this study certainly add to the body of knowledge regarding factors most likely to influence specialty choice and should give medical schools, as well as organizations like the AAFP that are hoping to increase medical student choice of family medicine, some ideas around how to prioritize our approach to creating that change."
Bentley called out an important distinction between the FMAHealth study and other published research on student choice: an emphasis on the student's perspective.
"We're not going to increase medical student choice of family medicine without listening to students and what's important to them," Bentley told AAFP News. "This was certainly time-intensive research, and we're so appreciative that the FMAHealth team took this on and shared their findings.
"It's important to see studies like this that focus on student perspectives to add to the body of research that also includes studies on outcomes of particular programs or educational models, as well as the relation of student choice of family medicine to larger societal, system and environmental changes," Bentley continued. "As the authors of the Four Pillars for Primary Care Physician Workforce Reform concluded, student choice is impacted significantly by the pipeline, process of medical education, practice transformation and payment. This study's authors focused on factors within the process of medical education."
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