BACKGROUND: Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents’ specialty choices have received little attention.
OBJECTIVE: To identify factors that predict the clinical practice of residents following their training.
DESIGN: Prospective cohort study.
PARTICIPANTS: Two hundred and four categorical residents from 2 university-based residency programs.
MEASUREMENTS: Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later.
RESULTS: International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%,P<.001). Residents with higher loan indebtedness more often became generalists (P=.001). A corresponding trend favoring general internal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%,P=.08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05<P<.10). In a logistic regression, graduation from a U.S. medical school (odds ratio [OR] 3.02; 95% confidence interval [CI], 1.00 to 9.10,P=.049] and perception of low future income (OR 1.65; 95% CI, 1.06 to 2.56,P=.03) predicted entry into general medicine, with trends apparent for higher debt (P=.05) and greater comfort caring for patients with psychological problems (P=.07).
CONCLUSION: Recruitment of IMGs may not increase the supply of General Internists. Prospects of lower income, even in the face of large debt, may not discourage residents from becoming generalists. If increasing generalist manpower is a goal, residencies should consider weighing applicants’ personal attributes during the selection process.
career choice general internal medicine health manpower international medical graduates
APDIM Match Newsletter, March 2005. Available at: www.im.org/AAIM/PublicPolicy/Docs/Match/1985–2005data.pdf. Accessed April 17, 2006.Google Scholar
Cohen JJ, Todd JS. Association of American Medical Colleges and American Medical Association joint statement on physician workforce planning and graduate medical education reform policies. JAMA. 1994;272:712.PubMedCrossRefGoogle Scholar
Anonymous. AAMC policy on the generalist physician. Acad Med. 1993;68:1−6.Google Scholar
Council on Graduate Medical Education. Fourth Report: Recommendations to Improve Access to Health Care Through Physician Workforce Reform. Rockville, MD: DHHS; 1994.Google Scholar
Cooper RA, Stoflet SJ, Wartman SA. Perceptions of medical school deans and state medical society executives about physician supply. JAMA. 2003;290:2992–5.PubMedCrossRefGoogle Scholar
Linzer M, Slavin T, Mutha S, et al. Admission, recruitment, and retention: finding and keeping the generalist-oriented student. J Gen Intern Med. 1994;9(suppl 1):S14-S23.PubMedCrossRefGoogle Scholar
Merrill JM, Laux LF, Lorimor R, Thornby JI, Vallbona C. Authoritarianism’s role in medicine. Am J Med Sci. 1995;310:87–90.PubMedGoogle Scholar
Merrill JM, Camacho Z, Laux LF, Thornby JI, Vallbona C. Machiavellianism in medical students. Am J Med Sci. 1993;305:285–8.PubMedCrossRefGoogle Scholar
Merrill JM, Lorimor RJ, Thornby JI, Vallbona C. Reliance on high technology among senior medical students. Am J Med Sci. 1998;315:35–9.PubMedCrossRefGoogle Scholar
Merrill JM, Camacho Z, Laux LF, Thornby JI, Vallbona C. How medical school shapes students’ orientation to patients’ psychological problems. Acad Med. 1991;66(suppl):S4-S6.PubMedGoogle Scholar
Merrill JM, Camacho Z, Laux LF, Lorimer R, Thornby JI, Vallbona C. Uncertainties and ambiguities: measuring how medical students cope. Med Educ. 1994;28:316–22.PubMedCrossRefGoogle Scholar
Merrill JM, Laux LF, Thornby JI. A measure of excessive “reliance on high technology” in medicine and what it means. South Med J. 1991;84:101–2.PubMedGoogle Scholar
Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY: John Wiley; 1989.Google Scholar
Weil PA, Schleiter MK, Tarlov AR. National study of internal medicine manpower: V. Comparison of residents in internal medicine—future generalists and subspecialists. Ann Intern Med. 1981;94:678–90.PubMedGoogle Scholar
Nelson HD, Matthews AM, Patrizio GR, Cooney TG. Managed care, attitudes, and career choices of internal medicine residents. J Gen Intern Med. 1998;13:39–42.PubMedCrossRefGoogle Scholar
Valente E, Wyatt SM, Moy E, Levin RJ, Griner PF. Market influences on internal medicine residents’ decisions to subspecialize. Ann Intern Med. 1998;128:915–21.PubMedGoogle Scholar
Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Acad Med. 2005;80:507–12.PubMedCrossRefGoogle Scholar
Grosso LJ, Goode LA, Kimball HR, Kooker DJ, Jacobs C, Lattie G. The subspecialization rate of third year internal medicine residents from 1992 through 1998. Teach Learn Med. 2004;16:7–13.PubMedCrossRefGoogle Scholar
Andersen RM, Lyttle CS, Kohrman CH, Levey GS, Clements MM. National study of internal medicine manpower: XIX. Trends in internal medicine residency training programs. Ann Intern Med. 1992;117:243–50.PubMedGoogle Scholar
Colquitt WL, Zeh MC, Killian CD, Cultice JM. Effect of debt on U.S. medical school graduates’ preferences for family medicine, general internal medicine, and general pediatrics. Acad Med. 1996;7:399–411.CrossRefGoogle Scholar
Anonymous. Evolution of medicine: subspecialization in internal medicine. Academic Internal Medicine Insight 2004:2(3):6. Available at: http://www.im.org/AAIM/Pubs/Insight/Fall2004/page6.pdf. Accessed September 8, 2005.Google Scholar