Demographic, educational, and psychosocial factors influencing the choices of primary care and academic medical careers.

Abstract

To identify demographic, psychosocial, and educational variables that differentiate physicians who have chosen careers in primary care from those who have chosen academic medicine. Questionnaires were distributed in the spring of 1992 to 704 physicians (546 in primary care practices and 143 in academic medicine) who had graduated from the University of Kentucky College of Medicine, 1964-1991. Mann-Whitney U tests and analyses of variance were used for statistical comparisons. A total of 336 physicians responded: 246 in primary care and 90 in academic medicine. The primary care physicians tended to come from smaller cities than did the academic physicians (p < .0001). The primary care physicians also had made their career choices earlier than did the academic physicians (p < .0001). For the academic physicians, long-term participation in research, intellectual stimulation, content of specialty, and influence of a mentor or role model were significantly more important factors than they were for the primary care physicians, for whom length of training, direct patient contact, and threats of malpractice suits were significantly more important. The results corroborate the findings of previous studies that suggest that career-choice factors are influenced by admission procedures and curricular structures. The number of graduates choosing careers in either primary care or academic medicine may be increased by increasing their experiences in those fields. Medical schools may be able to use demographic, psychosocial, and curricular factors to fulfill their particular primary mandates, whether they be producing physicians in primary care or in academic medicine.