Factors Influencing Medical Students' Specialty Choice: Insights to Address the Evolving Primary Care Gap

Introduction The current and projected nationwide shortage of primary care physicians necessitates studying factors that could influence students' specialty choice for their future medical practice. This study evaluates the influence of potential factors involved in students' decision-making process regarding specialty selection and proposes appropriate mitigations to enhance interest in primary care specialties. Methods Students completed an anonymous 43-question online survey distributed across three medical schools in Florida and California. The survey was sent to all medical students at these institutions, regardless of academic year. It included questions on demographics, specialty interests, perceived external prestige, financial goals, clinical experiences, and personal hobbies. Influential factors were measured using Likert scales. To identify students interested in primary care, we included those who ranked Family Medicine, Pediatrics, or Internal Medicine among their top three specialty choices. The survey was developed through an iterative process among the authors, with a focus on factors such as community perception, peer influence, financial incentives, and clinical exposure. Results One hundred students completed the survey, with only 26% (n=26) ranking surgery as their top choice, and 64% (n=64) of students including primary care in their top three choices. Students rated their top choice as having a better reputation in the healthcare field compared to primary care (p = 0.0028). Students also rated their top specialty choices as requiring a higher skill level compared to primary care (p = 0.0015). The median minimum level of income students would be satisfied with as an attending was $250-300k. Students who chose a minimum level of income below $300k were more likely to agree with the statement that a clinical experience made them choose their specialty (p = 0.016). Conclusion We found that students' specialty choices were influenced by income considerations, perceived biases against primary care within the healthcare community, and their own perceptions of their skill levels. Introducing early clinical exposure to primary care, such as incorporating primary care physicians as faculty and providing early hands-on experiences, may help improve perceptions of primary care specialties and foster greater student interest in these fields.