Objective. - To assess the specialty plans of current fourth-year medical students and, for those not choosing primary care specialties, to investigate the potential effect that changes in key economic or lifestyle factors could have in attracting such students to primary care. Design and Participants. - A survey study was sent to 901 fourth-year medical students in the 1993 graduating classes of six US medical schools. Outcome Measures. - Comparisons were made between students choosing and not choosing primary care specialties. For the non-primary care students, we also evaluated whether alteration of income, hours worked, or loan repayment could attract them to primary care careers. Results. - Of the 688 responses (76% response rate), primary care specialties were chosen by 27% of the students and non-primary care specialties by 73%. One quarter (25%) of the non-primary care students indicated they would change to primary care for one of the following factors: income (10%), hours worked (11%), or loan repayment (4%). For students whose debt was $50 000 or greater, the loan repayment option became much more important than for students with lesser debt. In all, a total of 45% (n=313) of the students indicated either they were planning to enter primary care (n=188) or they would change to a primary care specialty (n=125) with appropriate adjustments in income, hours worked, or loan repayment. Conclusion. - Significant changes in economic and lifestyle factors could have a direct effect on the ability to attract students to primary care. Including such changes as part of health system reform, especially within the context of a supportive medical school environment, could enable the United States to approach a goal of graduating 50% generalist physicians.
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