The Contribution of Childhood and Medical School Location to the Career Paths of Graduating Pediatrics Residents.
OBJECTIVE
To compare job search experience and postresidency position of pediatric residents on the basis of childhood location (United States or international) and medical school location (American medical graduates [AMG] or international medical graduate [IMG]).


METHODS
Annual national random samples of 1000 graduating pediatric residents from 2009 to 2013 were surveyed. Multivariable analyses, controlling for resident and program characteristics, compared job search experiences and postresidency positions among 4 groups categorized by childhood and medical school location: US-AMG, US-IMG, international-AMG, and international-IMG.


RESULTS
A total of 3027 graduating residents (61.1%) responded: 75.2% US-AMG, 15.8% international-IMG, 6.3% US-IMG, and 2.7% international-AMG. The 4 groups varied by demographics (age, race, gender, marital status, children, bi- or multilingual family), educational debt, residency program region and size, and Spanish proficiency (P < .01). The US-AMG were least likely to have a bi- or multilingual family (25.7%) or be proficient in Spanish (15.0%). One-third (34.5%) accepted fellowship positions. International-IMG and US-IMG were more likely than US-AMG to choose fellowship positions (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.52-2.74; aOR, 1.77; 95% CI, 1.25-2.52, respectively). Among residents who applied for general pediatric or hospitalist positions, 23.1% reported moderate to considerable difficulty in their job search, and 44.1% accepted positions in underserved areas. International-IMG and US-IMG were more likely than US-AMG to report job search difficulty (aOR, 2.49; 95% CI, 1.55-3.98; aOR, 1.78; 95% CI, 1.04-3.06, respectively), and international-IMG were more likely to accept positions in underserved areas (aOR, 1.68; 95% CI, 1.07-2.63).


CONCLUSIONS
Multiple factors are involved in pediatrician's career choices. When childhood location is considered with medical school location, there were differences between groups in demographics, job search difficulty, and career intentions.
Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash. Electronic address: rumoren@wu.edu.
Rachel
R
Umoren
Department of Communication Studies, Indiana University East, Richmond, Ind.
Natalia
N
Rybas
Department of Research, American Academy of Pediatrics, Elk Grove Village, Ill.
Mary Pat
MP
Frintner
D000328:Adult; D002321:Career Choice; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005257:Fellowships and Scholarships; D005260:Female; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data*; D005843:Geography; D006801:Humans; D007396:Internship and Residency; D008297:Male; D015999:Multivariate Analysis; D010372:Pediatrics / Q000193:education*; D012577:Schools, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014146:Training Support; D014481:United States
career choice; international medical school graduates; job search; pediatrics; residents