INFLUENCE OF INCOME, HOURS WORKED, AND LOAN REPAYMENT ON MEDICAL-STUDENTS DECISION TO PURSUE A PRIMARY-CARE CAREER

Objective.-To assess the specialty plans of current fourth-year medica l students and, for those not choosing primary care specialties, to in vestigate the potential effect that changes in key economic or lifesty le factors could have in attracting such students to primary care. Des ign and Participants.-A survey study was sent to 901 fourth-year medic al students in the 1993 graduating classes of six US medical schools. Outcome Measures.-Comparisons were made between students choosing and not choosing primary care specialties. For the non-primary care studen ts, we also evaluated whether alteration of income, hours worked, or l oan repayment could attract them to primary care careers. Results.-Of the 688 responses (76% response rate), primary care specialties were c hosen by 27% of the students and non-primary care specialties by 73%. One quarter (25%) of the non-primary care students indicated they woul d change to primary care for one of the following factors: income (10% ), hours worked (11%), or loan repayment (4%). For students whose debt was $50 000 or greater, the loan repayment option became much more im portant than for students with lesser debt. In all, a total of 45% (n= 313) of the students indicated either they were planning to enter prim ary care (n=188) or they would change to a primary care specialty (n=1 25) with appropriate adjustments in income, hours worked, or loan repa yment. Conclusion.-Significant changes in economic and lifestyle facto rs could have a direct effect on the ability to attract students to pr imary care. Including such changes as part of health system reform, es pecially within the context of a supportive medical school environment , could enable the United States to approach a goal of graduating 50% generalist physicians.