Factors associated with medical students' career choices regarding internal medicine.
BACKGROUND
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.


OBJECTIVE
To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making.


METHODS
Web-based cross-sectional survey of 1177 fourth-year medical students (82% response rate) at 11 US medical schools in spring 2007.


METHODS
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.
Hauer
Karen E
KE
Department of Medicine, University of California, San Francisco, 533 Parnassus Ave, U137, Box 0131, San Francisco, CA 94143-0131, USA. khauer@medicine.ucsf.edu
Durning
Steven J
SJ
Kernan
Walter N
WN
Fagan
Mark J
MJ
Mintz
Matthew
M
O'Sullivan
Patricia S
PS
Battistone
Michael
M
DeFer
Thomas
T
Elnicki
Michael
M
Harrell
Heather
H
Reddy
Shalini
S
Boscardin
Christy K
CK
Schwartz
Mark D
MD
D000328:Adult; D002321:Career Choice; D003430:Cross-Sectional Studies; D004501:Education, Medical; D005163:Factor Analysis, Statistical; D005260:Female; D006280:Health Workforce; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008019:Life Style; D016015:Logistic Models; D008297:Male; D013038:Specialization; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States