title: Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review.
abstract: OBJECTIVE
  To determine which factors influence a medical student's decision to choose a career in primary care; and to establish if these factors are similar or different among students in high-, middle- and low-income countries.
  
  
  METHODS
  An extensive search was done of PubMed, Google Scholar, and Virtual Library of Health for articles on primary care careers published in 2003-2013 in English, Spanish, and/or Portuguese. Initially, 600 records were identified; 74 full-text articles were assessed for eligibility and 55 were selected (42 from high-income countries; 13 from middle- and low-income). These were assessed to identify intrinsic and extrinsic factors that influence career choice among medical students from high-, middle-, and low-income countries.
  
  
  RESULTS
  A comparison framework with common and specific factors that influence career choice in primary care among medical students from high-, middle- and low-income was developed. Factors were classified as extrinsic or intrinsic, and as facilitators or barriers. Several factors common to all countries were identified: facilitators were exposure to rural location, role models, working conditions; barriers were low income, prestige, and medical school environment. Some factors specific to middle- and low-income countries were: understanding of rural needs and intellectual challenge. Other factors specific to high-income countries were: attitude towards social problems, voluntary work, influence of family, and length of residency.
  
  
  CONCLUSIONS
  Further studies on the subject are needed, especially in low- and middle-income countries. Identifying factors as barriers or facilitators for career choice will promote a better understanding of the reasons behind the shortage of primary care professionals and will contribute to policy building, improved training, and recruitment and retention of these professionals.
authors.affiliation: Pan American Health Organization, Tegucigalpa, Honduras, puertasb@paho.org.
authors.forename: E Benjamín
authors.initials: EB
authors.lastname: Puertas
authors.affiliation: Pan American Health Organization, Lima, Peru.
authors.forename: Carlos
authors.initials: C
authors.lastname: Arósquipa
authors.affiliation: Pan American Health Organization, Lima, Peru.
authors.forename: Daniela
authors.initials: D
authors.lastname: Gutiérrez
mesh_terms: D002321:Career Choice; D019049:Developed Countries / Q000191:economics / Q000706:statistics & numerical data; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D009042:Motivation; D011320:Primary Health Care; D013337:Students, Medical / Q000523:psychology*; D000078329:Workforce