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Acad Med. 2013 Oct;88(10):1522-8. doi: 10.1097/ACM.0b013e3182a316eb.

Primary care, the ROAD less traveled: what first-year medical students want in a specialty.

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Ms. Clinite is a fourth-year medical student, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Dr. Reddy is associate professor, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Ms. Kazantsev is a third-year medical student, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Dr. Kogan is associate professor, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Durning is professor of medicine and pathology, Uniformed Services University, Bethesda, Maryland. Ms. Blevins is director, Student and Career Development, University of Colorado School of Medicine, Denver, Colorado, and member, Association of American Medical Colleges Careers in Medicine Advisory Committee. Dr. Chou is professor, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California. Dr. Diemer is director, Undergraduate Medical Education, and residency program director, Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Dunne is professor and internal medicine clerkship director, Yale University School of Medicine, and associate program director, Yale Traditional Internal Medicine Residency, New Haven, Connecticut. Dr. Fagan is professor of medicine and internal medicine clerkship director, Alpert Medical School of Brown University, Providence, Rhode Island. Dr. Hartung is professor of family and community medicine, Northeast Ohio Medical University, Rootstown, Ohio. Dr. Mechaber is assistant professor of medicine and assistant dean of student services, University of Miami Miller School of Medicine, Miami, Florida. Dr. Paauw is professor of medicine, University of Washington School of Medicine, and Rathmann Family Foundation Endowed Chair for Patient Centered Clinical Education, Seattle, Washington. Dr. Wong is senior associate dean emeritus of medical education an



Medical students are increasingly choosing non-primary-care specialties. Students consider lifestyle in selecting their specialty, but how entering medical students perceive lifestyle is unknown. This study investigates how first-year students value or rate lifestyle domains and specialty-selection characteristics and whether their ratings vary by interest in primary care (PC).


During the 2012-2013 academic year, the authors conducted a cross-sectional survey of first-year medical students from 11 MD-granting medical schools. Using a five-point Likert-type scale (1 = not important at all; 5 = extremely important), respondents rated the importance of 5 domains of good lifestyle and 21 characteristics related to specialty selection. The authors classified students into five groups by PC interest and assessed differences by PC interest using one-way analysis of variance.


Of 1,704 participants, 1,020 responded (60%). The option "type of work I am doing" was the highest-rated lifestyle domain (mean 4.8, standard deviation [SD] 0.6). "Being satisfied with the job" was the highest-rated specialty-selection characteristic (mean 4.7, SD 0.5). "Availability of practice locations in rural areas" was rated lowest (mean 2.0, SD 1.1). As PC interest decreased, the importance of "opportunities to work with underserved populations" also decreased, but importance of "average salary earned" increased (effect sizes of 0.98 and 0.94, respectively).


First-year students valued enjoying work. The importance of financial compensation was inversely associated with interest in PC. Examining the determinants of enjoyable work may inform interventions to help students attain professional fulfillment in PC.

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