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Factors Associated With Medical School Graduates' Intention to Work With Underserved Populations: Policy Implications
Andrea N Garcia1, Tony Kuo, Lisa Arangua
1A.N. Garcia is a fellow with the National Clinician Scholars Program at the University of California, Los Angeles. At the time of submission, the author was a general and preventive medicine resident, California Department of Public Health, Sacramento, California, assigned to the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California. The project was conceived while the author was a medical student at the University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9284-3790. T. Kuo is adjunct associate professor of epidemiology, UCLA Fielding School of Public Health, and health sciences associate professor of family medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. The author also directs the Division of Chronic Disease and Injury Prevention and the Office of Senior Health, Los Angeles County Department of Public Health, Los Angeles, California; ORCID: http://orcid.org/0000-0002-4120-8559. L. Arangua is a policy analyst, Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California; ORCID: http://orcid.org/0000-0001-9105-3885. E.J. Pérez-Stable is director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland. This project was conceived while the author was professor of medicine and chief, Division of General Internal Medicine, Department of Medicine, and director, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, San Francisco, California.
Purpose:
Given projected U.S. physician shortages across all specialties that will likely impact underserved areas disproportionately, the authors sought to explore factors most correlated with medical school graduates' intention to work with underserved populations (IWUP).
Method:
Data from the 2010-2012 Association of American Medical Colleges Medical School Graduation Questionnaire (n = 40,846) were analyzed. Variables (demographics, career preference, debt burden, intention to enter loan forgiveness programs) were examined using chi-square tests and logistic regression models.
Results:
Respondents included 49.5% (20,228/40,846) women, 16.6% (6,771/40,837) underrepresented minorities (URMs), and 32.4% (13,034/37,342) with primary care intent. The median educational debt was $160,000. Respondents who were women (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.49, 1.70), URMs (aOR 2.50, 95% CI 2.30, 2.72), intended to enter loan forgiveness programs (aOR 2.44, 95% CI 2.26, 2.63), intended to practice primary care (aOR 1.65, 95% CI 1.54, 1.76), and intended to emphasize nonclinical careers (aOR 1.23, 95% CI 1.11, 1.37) had greater odds of reporting IWUP. Among those who chose specialties and careers with a nonclinical emphasis, and among those with greater burdens of educational and consumer debt, URMs were nearly twice as likely as other minorities and whites to report IWUP.
Conclusions:
Findings suggest physician characteristics that may be associated with filling workforce gaps in underserved areas. Restructuring financial incentive programs to support physician leaders and specialists with characteristics associated with IWUP may complement similar policies in primary care and could have key impacts on health equity in underserved areas.
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