34699 Early life socioeconomic factors that influence specialty choice and USMLE test performance in United States medical residents: A single institution cross-sectional survey study

Abstract

Studies show that minorities are underrepresented in high-paying subspecialties. Additional study is needed to further examine the extent to which early life socioeconomic background influences US physicians’ academic performance and medical specialty choice. We distributed a Qualtrics survey to all house-staff at Saint Louis University (approximately 600 physicians) and to other dermatology programs through a national Dermatology Program Directors Listserv. Survey respondents were asked about their demographics, family socioeconomic status, medical specialty, United States Medical Licensing Exam (USMLE) Step 1 scores, and amount of debt from loans. The medical specialties were grouped into 3 categories based on level of competitiveness according to 2020 NMRP applicant match data: least competitive with average Step 1 scores of 220-229, medium competitive with scores of 230-239, and highly competitive with scores of >240. Respondents were also stratified into low, medium, and high-risk groups based on having certain risk factors, including being female, nonwhite, non-Asian, foreign-born, and having a childhood household income <$50,000. Univariate analysis was performed. Average Step 1 scores were higher in respondents in the low-risk group (238) compared with respondents in high-risk groups (210), P = .016. More respondents in the low-risk group matched into competitive versus noncompetitive specialties (42% versus 35%), and more respondents in the medium risk group matched into noncompetitive versus competitive specialties (65% versus 55%). This study demonstrates that early life socioeconomic factors influence academic performance and specialty choice. The study is limited because it does not capture the personal preferences that factor into specialty choice.