Abstract
[This is an excerpt.] Unlike many Western nations, the United States does not manage or actively regulate the number, type,or geographic distribution of its physician workforce. As a result, medical trainees choose how and whereto work. As with most free markets, equitable distribution is at risk without well-informed, evidence-basedpolicies and incentives capable of promoting equitable access to appropriate care. This study contributesto understanding of important policy options and incentives by identifying factors that influence medicalstudent and resident choices about medical specialties and location of practice. Specifically, it identifiesfactors that are associated with choice of primary care specialties, particularly family medicine, and withcaring for rural and underserved populations. Prior studies of the impact of debt on student specialty choice have revealed mixed effects. Recentstudies suggest that physician payment disparities and the medical school learning environment arepotent factors for specialty choice, and that exposure to Federal Title VII grant-funded programs duringmedical school and residency is associated with higher likelihood of students choosing primary care specialties and practice in underserved settings. Most studies of specialty choice or practice locationfocus on the decisions students make at graduation or immediately thereafter. This study is perhaps themost comprehensive to date, as it examines multiple factors along the training path and how they relateto the end result, which is specialty of physician practice and where they practice. This study incorporates nearly 20 years worth of survey data from graduating medical students about their experiences, their debt, their beliefs, and their intentions. It includes historical files over the same period of exposure to Title VII funds during training, and of participation in National Health Service Corps(NHSC). It includes cross-sectional data about physicians' current specialties and practice locations, anda five-year cross-section of service in Rural and Federally Qualified Health Centers. All of these data about individual physicians were brought together to test for associations between student characteristics and training influences that may have policy relevance for a more purposefully produced health care workforce.
This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing).
