title: Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.
abstract: Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine.
  
  
  
  We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices.
  
  
  
  This was a qualitative study based on semi-structured, in-person interviews.
  
  
  
  Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed.
  
  
  
  We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis.
  
  
  
  We completed 24 interviews (12 second-year residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program.
  
  
  
  Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue a career in primary care.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT, 06520, USA. theodore.long@yale.edu.|Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. theodore.long@yale.edu.
authors.forename: Theodore
authors.initials: T
authors.lastname: Long
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Krisda
authors.initials: K
authors.lastname: Chaiyachati
authors.affiliation: Yale School of Medicine, New Haven, CT, USA.
authors.forename: Olatunde
authors.initials: O
authors.lastname: Bosu
authors.affiliation: Yale School of Public Health, New Haven, CT, USA.
authors.forename: Sohini
authors.initials: S
authors.lastname: Sircar
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Richards
authors.affiliation: Department of Internal Medicine, Medical School of Brown University, Providence, RI, USA.
authors.forename: Megha
authors.initials: M
authors.lastname: Garg
authors.affiliation: Department of Internal Medicine, Medical School of Brown University, Providence, RI, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: McGarry
authors.affiliation: Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Sonja
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Berman
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT, 06520, USA.|Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.|Yale School of Public Health, New Haven, CT, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Curry
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: John
authors.initials: J
authors.lastname: Moriarty
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Huot
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000639:trends*; D007396:Internship and Residency / Q000379:methods / Q000639:trends*; D008297:Male; D010820:Physicians / Q000523:psychology / Q000639:trends*; D011320:Primary Health Care / Q000379:methods / Q000639:trends*; D011795:Surveys and Questionnaires
keywords: Meducation; Primary care; Qualitative research; Workforce