WHY STUDENTS CHOOSE A PRIMARY-CARE OR NONPRIMARY CARE CAREER

PURPOSE: To analyze the factors influencing students to choose residen cy training in primary care (internal medicine, family medicine, and p ediatrics) or nonprimary care specialties and study the combined effec t of reported responses on their choice. MATERIALS AND METHODS: A 12-i tem questionnaire using a 7-point Likert scale was mailed to the 1,164 graduating seniors from 9 medical schools in 1991. Responses ranged f rom 1, very negative influence, to 7, very positive influence. Four in dicated no influence. The overall response rate was 69%. Univariate an alysis of factors associated with specialty choice was done with the M antel-Haenzsel chi-square test. Odds ratios were calculated for each s ignificant variable without controlling for other variables. Factors f ound to have univariate significance were then tested for combined sig nificance with logistic regression analysis. The regression was perfor med on a randomly chosen training sample, and validated on a test samp le. RESULTS: Forty-five percent of respondents chose an internship and planned residency training in a primary care specialty. Factors that remained positively associated with choosing a primary care specialty when controlling for other factors were desire to provide comprehensiv e care, to keep options open, and to undertake ambulatory care. Desire for monetary reward was negatively associated with choice of a primar y care specialty. CONCLUSIONS: Positive educational experiences in the ambulatory setting should be enhanced, and disparity in remuneration among disciplines reduced.