Primary Care, the ROAD Less Traveled: What First-Year Medical Students Want in a Specialty

Purpose 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). Method 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. Results 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). Conclusions 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.