The relationship between matriculating medical students' planned specialties and eventual rural practice outcomes.
OBJECTIVE
To analyze the previously unknown relationships between the specialty plans of entering medical students and their eventual rural practice outcomes.


METHODS
For 5,419 graduates from the 1978-2002 classes of Jefferson Medical College, their self-reported specialty plans at the time of matriculation were obtained from the Jefferson Longitudinal Study, as were their 2007 practice locations. Specialty plans were grouped into 12 categories, and the percentages of graduates initially planning each specialty group who were actually practicing in rural areas were determined.


RESULTS
Entering medical students' specialty plans were strongly related to eventual rural practice (P < .001). Those students planning family medicine were "highly likely" to practice in rural areas (29.4%, 238/810). They were 1.5 times as likely to practice rural as a "mid-likely" group (those planning general surgery, psychiatry, emergency medicine, general internal medicine, or one of the medical subspecialties: 19.6% [range 17.9%-21.0%], 229/1,167). Students planning family medicine were also 2.1 times as likely to practice rural as those students planning a "lower-likely" group (those planning general pediatrics, one of the surgical subspecialties, the hospital specialties of radiology, anesthesiology and pathology, and obstetrics-gynecology, or other specialties: 14.0% [range 13.0%-14.3%], 142/1,016).


CONCLUSIONS
These findings show that students' specialty plans at medical school matriculation are significantly related to rural outcomes, and they provide new information quantifying the absolute and relative likelihood of those planning various specialties to enter rural practice. This information is particularly important for medical schools that have or plan to develop comprehensive rural programs.
Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA. Howard.Rabinowitz@jefferson.edu
Howard K
HK
Rabinowitz
James J
JJ
Diamond
Fred W
FW
Markham
Abbie J
AJ
Santana
D002321:Career Choice; D016009:Chi-Square Distribution; D004504:Education, Medical, Undergraduate; D005194:Family Practice / Q000193:education; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008507:Medically Underserved Area; D010414:Pennsylvania; D010820:Physicians / Q000600:supply & distribution*; D012111:Residence Characteristics; D019035:Rural Health Services; D012424:Rural Population; D057566:Self Report; D013038:Specialization; D013337:Students, Medical / Q000523:psychology*; D000078329:Workforce