title: Predictors of final specialty choice by internal medicine residents.
abstract: BACKGROUND
  Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention.
  
  
  OBJECTIVE
  To identify factors that predict the clinical practice of residents following their training.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two hundred and four categorical residents from 2 university-based residency programs.
  
  
  METHODS
  Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later.
  
  
  RESULTS
  International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, P < .001). Residents with higher loan indebtedness more often became generalists (P = .001). A corresponding trend favoring general internal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%, P = .08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05 < P < .10). In a logistic regression, graduation from a U.S. medical school (odds ratio [OR] 3.02; 95% confidence interval [CI], 1.00 to 9.10, P = .049) and perception of low future income (OR 1.65; 95% CI, 1.06 to 2.56, P = .03) predicted entry into general medicine, with trends apparent for higher debt (P = .05) and greater comfort caring for patients with psychological problems (P = .07).
  
  
  CONCLUSIONS
  Recruitment of IMGs may not increase the supply of General Internists. Prospects of lower income, even in the face of large debt, may not discourage residents from becoming generalists. If increasing generalist manpower is a goal, residencies should consider weighing applicants' personal attributes during the selection process.
authors.affiliation: Division of General Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Diehl@uthscsa.edu
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Diehl
authors.forename: Vineeta
authors.initials: V
authors.lastname: Kumar
authors.forename: Ann
authors.initials: A
authors.lastname: Gateley
authors.forename: Jane L
authors.initials: JL
authors.lastname: Appleby
authors.forename: Mary E
authors.initials: ME
authors.lastname: O'Keefe
mesh_terms: D000328:Adult; D002755:Choice Behavior; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007388:Internal Medicine / Q000639:trends; D007396:Internship and Residency / Q000639:trends; D008297:Male; D008511:Medicine / Q000639:trends; D016017:Odds Ratio; D010551:Personality; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013038:Specialization