Addressing the Enduring Primary Care Physician Shortage in The United States: The Direct and Indirect Effects of Gender on the Medical Specialty Decision-Making Process

Authors

  • Kelly Rhea MacArthur University of Nebraska Omaha, Omaha, USA.
  • Emily Royer University of Nebraska Medical Center, College of Medicine, Omaha, USA.
  • Daniel N. Hawkins University of Nebraska Omaha, Omaha, USA.

DOI:

https://doi.org/10.5195/ijms.2018.296

Keywords:

Medical Education, Primary Health Care, Medical Specialty, Gender Identity, Physician Shortage Area

Abstract

Background: There has been an enduring primary care (PC) physician shortage in the United States (U.S.) for decades, which is projected to worsen. With women entering PC at significantly higher rates than men, the aim of this study was to explore various pathways through which gender may affect the medical specialty decision-making process.

Methods: Using data from the National Survey of Attitudes and Choices in Medical Education and Training (ACMET) II on a sample of 492 medical residents, this study employed structural equation modeling (SEM) to explore how gender shaped residents’ preferences for future practice and their perceptions of PC, and how their experiences with faculty affected the medical specialty decision-making process.

Results: As expected, women were significantly more likely than men to report choosing PC. This study also found that there were several indirect pathways through which gender affects specialty choice, including through negative perceptions about PC and the time spent with PC faculty in medical school.

Conclusion: Given the multiple pathways through which gender affects the medical specialty decision-making process, this study highlights a need for gender-specific interventions when addressing the enduring PC physician shortage in the U.S. Specifically, the results of this study suggest that increasing the time that male medical students spend in PC through structural changes in medical education might mitigate negative perceptions about PC and encourage males to enter PC at higher rates. Future research should assess the effectiveness of such gender-specific interventions.

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Author Biography

Kelly Rhea MacArthur, University of Nebraska Omaha, Omaha, USA.

Dr. Kelly Rhea MacArthur is an Assistant Professor at the Department of Sociology and Anthropology, University of Nebraska Omaha, Omaha, USA.

References

Petterson SM, Liaw WR, Phillips RL, Rabin DL, Meyers DS, Bazemore AW. Projecting US primary care physician workforce needs: 2010-2025. Ann Family Med. 2012 Nov 1;10(6):503-9.

Agency for Healthcare Research and Quality. Fact Sheets: The Number of Practicing Primary Care Physicians in the United States. Available at: http://www.ahrq.gov/research/findings/factsheets/primary/pcwork1/index.html.

Association of American Medical Colleges. Workforce Studies. Available at: http://www.aamc.org/workforce.

Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res. 2003 Jun;38(3):831-65.

Newton DA, Grayson MS. Trends in career choice by US medical school graduates. Jama. 2003 Sep 3;290(9):1179-82.

Senf JH, Campos-Outcalt D, Kutob R. Factors related to the choice of family medicine: a reassessment and literature review. J Am Board Fam Pract. 2003 Nov-Dec;16(6):502-12.

Dill MJ, Salsberg ES. The complexities of physician supply and demand: projections through 2025. Association of American Medical Colleges; 2008.

Tu HT, O’Malley AS. Exodus of male physicians from primary care drives shift to specialty practice. Tracking Report. 2007 Jun;17:1-6.

Brotherton SE, Rockey PH, Etzel SI. US graduate medical education, 2004-2005: trends in primary care specialties. Jama. 2005 Sep 7;294(9):1075-82.

Bland CJ, Meurer LN, Maldonado G. Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. 1995 Jul 1:70(7):620-41.

Lambert EM, Holmboe ES. The relationship between specialty choice and gender of US medical students, 1990–2003. Acad Med. 2005 Sep 1;80(9):797-802.

Woodworth PA, Chang FC, Helmer SD. Debt and other influences on career choices among surgical and primary care residents in a community-based hospital system. The Am Surg. 2000 Dec 1;180(6):570-6.

Rosenblatt RA, Andrilla CH. The impact of US medical students' debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire. Acad Med. 2005 Sep 1;80(9):815-9.

Hoff T. Practice under pressure: Primary care physicians and their medicine in the twenty-first century. Rutgers University Press; 2009 Sep 11.

Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. Jama. 2003 Sep 3;290(9):1173-8.

Lind DS, Cendan JC. Two decades of student career choice at the University of Florida: increasingly a lifestyle decision. Am Surg. 2003;69(1):53.

Boulis AK, Jacobs JA. The changing face of medicine: women doctors and the evolution of health care in America. Cornell University Press; 2008 Oct 9.

Bickel J, Ruffin A. Gender-associated differences in matriculating and graduating medical students. Acad Med. 1995 Jun;70(6):552-9.

Campos-Outcalt D, Senf J, Watkins AJ, Bastacky S. The effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician careers: a review and quality assessment of the literature. Acad Med. 1995 Jul;70(7):611-9.

Block, Susan D. National Survey of Attitudes and Choices in Medical Education and Training (ACMET) II, 1997 [Computer file]. ICPSR version. Boston, MA: University of Massachusetts-Boston Center for Survey Research [producer], 1997. Ann Arbor, MI: Interuniversity Consortium for Political and Social Research [distributor], 2002

Muthen LK. Mplus: Statistical Analysis with Latent Variables (Version 4.21) Computer software.

Kline RB. Principles and practice of structural equation modeling. Guilford publications; 2015 Nov 3.

Wendel TM, Godellas CV, Prinz RA. Are there gender differences in choosing a surgical career?. Surgery. 2003 Oct 1;134(4):591-6.

Gonzales AO, Westfall J, Barley GE. Promoting medical student involvement in primary care research. Fam Med. 1998 Feb;30(2):113-6.

Pfarrwaller E, Sommer J, Chung C, Maisonneuve H, Nendaz M, Perron NJ, Haller DM. Impact of interventions to increase the proportion of medical students choosing a primary care career: a systematic review. J Gen Intern Med. 2015 Sep 1;30(9):1349-58.

Doucet H, Shah MK, Cummings TL, Kahn MJ. Comparison of internal medicine, pediatric, and medicine/pediatrics applicants and factors influencing career choices. South Med J. 1999 Mar;92(3):296-9.

Harris MC, Marx J, Gallagher PR, Ludwig S. General vs subspecialty pediatrics: factors leading to residents’ career decisions over a 12-year period. Arch Pediatr Adolesc Med. 2005 Mar 1;159(3):212-6.

Osborn EH. Factors influencing students' choices of primary care or other specialties. Acad Med. 1993 Jul;68(7):572-4.

Xu G, Rattner SL, Veloski JJ, Hojat M, Fields SK, Barzansky B. A national study of the factors influencing men and women physicians' choices of primary care specialties. Acad Med. 1995 May;70(5):398-404.

Association of American Medical Colleges (AAMC). 2017. Number of Active Residents, by Type of Medical School, GME Specialty, and Sex. 2016-2017 Active Residents. Available at: https://www.aamc.org/data/493922/report-on-residents-2018-b3table.html.

Published

2018-12-23

How to Cite

MacArthur, K. R., Royer, E., & Hawkins, D. N. (2018). Addressing the Enduring Primary Care Physician Shortage in The United States: The Direct and Indirect Effects of Gender on the Medical Specialty Decision-Making Process. International Journal of Medical Students, 6(3), 91–97. https://doi.org/10.5195/ijms.2018.296