Meeting the Need for Emergency Medicine Physicians: A National Study of Factors Influencing Medical Specialty Career Choice

Abstract

Objective: The process by which medical students choose a specialization is incompletely understood, especially as related to factors that influence changes in specific career interest during medical school. Women and Underrepresented in Medicine (URiM) students are less likely than their peer to apply for residency in emergency medicine (EM). Identifying whether medical students from these groups have baseline differences in their career interests or if the lower likelihood in planning a career in certain medical specialties develops during medical school. However, comparison to other major medical specialty patterns will provide the first steps toward a general understanding of the mechanisms at play. Hypothesis: First, female and URiM students have lower interest in EM even after controlling for other factors. Second, career interest in EM for both groups would be like other students at medical school onset and that a “cooling out” of interest would occur. Third, that women and URiM physicians would exhibit no difference in EM career persistence. Fourth, female and male students enter medical school with similar interest in fields like internal medicine and surgery and women will have higher odds of an interest in fields with typically more female physicians such as pediatrics and OB/GYN. Fifth, URiM students will have equivalent interests not non-URiM students. Sixth, women will both be “cooled out” and under-recruited. Fourth, URiM medical specialty interest will remain relatively stable from entry of medical school to graduation. Methods: Secondary data analyses was conducted on a cross-section of all residency applicants from 2005-2010. Data sources included: AAMC, NBME, AMA. Binary logistic regression models (BLM) were fitted with the outcomes: a planned career in EM at medical school entry, planned career in EM at graduation, and continued practice in EM. BLMs were also fitted with the outcomes: a planned career in one of four medical specialties (Internal Medicine, Pediatrics, OB/GYN, and General Surgery/Surgical Specialties) at medical school entry and again at graduation. Regression models included demographics, student attitudes, debt, undergraduate GPA and standardized test scores, and, medical school experiences. Results: URiM students expressed less interest in a career in EM when entering medical school and at graduation. No gender differences in interest existed at medical school onset. Women were less likely to enter EM by the time of medical school graduation. After residency, both female and URiM students had similar persistence in EM as all other graduates. Women were less likely to be interested in a career in Internal Medicine and Surgery and more interested in Pediatrics and OB/GYN at the start of medical school while URiM students expressed more interest in OB/GYN and Surgery. At graduation, women were still less likely to enter Internal Medicine and Surgery and more interested in OB/GYN and Surgery. URiM students were more likely to enter in Internal Medicine and less likely Pediatrics. Conclusions: Female and URiM medical students were less likely to enter EM. Women were less likely to develop a career interest in EM. While URiM students were less interested in EM generally, those initially interested in EM had a “cooling out” effect. Women have stable preferences regarding planned medical specialties in other specialties. In contrast, URiM students enter medical school more likely to enter OB/GYN and Surgical careers but at graduation were more likely to plan on Internal Medicine and less likely Pediatrics.