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Original Contribution
September 10, 2008

Factors Associated With Medical Students' Career Choices Regarding Internal Medicine

Author Affiliations

Author Affiliations: University of California, San Francisco (Drs Hauer, O’Sullivan, and Boscardin); Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Durning); Yale University, New Haven, Connecticut (Dr Kernan); Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Fagan); George Washington University, Washington, DC (Dr Mintz); University of Utah, Salt Lake City (Dr Battistone); Washington University in St Louis, St Louis, Missouri (Dr DeFer); University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Elnicki); University of Florida, Gainesville (Dr Harrell); University of Chicago, Chicago, Illinois (Dr Reddy); New York University, New York (Dr Schwartz).

JAMA. 2008;300(10):1154-1164. doi:10.1001/jama.300.10.1154

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.