Practice In Underserved Areas Research Articles

Medical Student Intent to Practice in Underserved Areas.

Medical Student Intent to Practice in Underserved Areas.

Just pass it: NAATP backs both SUPPORT Act versions

The SUPPORT Act reauthorization was passed five years ago, but has yet to be funded. In December before Congress went on vacation for the holiday, the House of Representations passed their version of the new bill, H.R. 4531 (H.R.4531 ‐ Support for Patients and Communities Reauthorization Act). Mark Dunn, lobbyist for the National Association of Addiction Treatment Providers (NAATP), reported back at the end of the year that this version “provides continued coverage for Medicaid individuals who are incarcerated and made positive changes to the IMD [Institution for Mental Diseases] exclusion,” as well as funding the previous programs. In the Senate, two committees advanced that version of the bill (S. 3393 SUPPORT Act). “The Senate bill provides a 70% increase in funding for training of mental health and substance use disorder professionals and a 25% increase in student loan forgiveness for counselors who practice in underserved areas,” Dunn reported. The Senate bill would require the federal government to study whether peer support individuals should be excluded if they have criminal histories, as some states already screen them out, which, as Dunn noted, “eliminates a segment of people in recovery.” NAATP has been advocating for passage and for many of the components included in both bills, Dunn said. “While all our priorities were not included, major advancements were made. We will continue to work with the various congressional leaders as the legislative process continues.” The next steps will be for the full Senate to consider and pass its version of the Support Act reauthorization, and then the two bodies will reconcile the two bills before final passage by both congressional bodies.

Impact of Dental Institutions' Values on Students' Intent to Practice in Underserved Communities: A Cross-sectional Study.

To evaluate how an institution's values can impact students' intent to practice in underserved areas. The values of 71 accredited dental schools in the United States were searched and tabulated. The American Dental Education Association (ADEA) survey results were used to tabulate the desire to serve the underserved population before entering dental school and upon graduation. Additionally, responses on the total amount of educational debt on graduation was compiled for LLUSD and all other dental schools. Fisher's exact test was performed to compare the difference between the two cohorts and Wilcoxon test was used to assess difference within the groups. Tests were conducted at an alpha level of 0.05 with SAS v 9.1.3 (SAS Institute, Cary, NC, USA). The top five values of US dental institutions based on frequency were excellence, diversity/inclusion, integrity, innovation, and respect. There was no statistically significant difference between LLUSD and all other dental schools in their desire to serve the underserved community upon graduation (p > 0.05, in all instances). Overall, there was a trend that upon graduation, the desire to serve the underserved had less impact on students' decision-making on their career choices. This drop in the desire to serve the underserved was statistically significant within both cohorts in the year 2021 (p < 0.001). Dental institutions should focus on better understanding of how their values impact their students' career choices so that they can develop strategies to better align their values with the mission of addressing the dentist shortage in underserved areas. Dental institutions' values play a major role in impacting students' career choices upon graduation and should be assessed using metrics that are measurable.

Undue Burden the Medical School Application Process Places on Low-Income Latinos

Undue Burden the Medical School Application Process Places on Low-Income Latinos

US Medical Student Plans to Practice in Underserved Areas

This study explores US medical students’ intent to practice in underserved areas, analyzed by demographic characteristics.

Changing Faces: Factors Associated with the Intention to Pursue Plastic Surgery and Practice in Underserved Areas.

De-identified data for US medical school graduates were obtained from the Association of American Medical Colleges for students who matriculated in academic years 2007-2008 and 2011-2012. Data collected included self-reported demographic and future practice intentions. Multivariate analysis was conducted to determine indicators of students' interest in plastic surgery, and their intention to practice in underserved areas. Of the 57,307 graduating US medical students in our cohort who completed the Graduation Questionnaire, 532 (0.9%) reported an intention to pursue plastic surgery. Hispanic [adjusted odds ratio (aOR): 1.45; 95% confidence interval (95% CI), 1.07-1.98] and multiracial (aOR: 1.59; 95% CI, 1.03-2.45) students were more likely to pursue plastic surgery compared with other surgical specialties. Among students interested in plastic surgery, compared with non-Hispanic White students, Black (aOR: 6.15; 95% CI, 1.96-19.26) students were more likely to report intention to practice in underserved areas. Students with community-engagement experiences were more likely to report intention to practice in underserved areas. Diversity among medical trainees pursuing plastic and reconstructive surgery is critical for maintaining and expanding plastic surgery services rendered in underserved areas. These findings suggest that student demographics and experiences with community-engagement experiences are positive indicators of practicing in underserved communities.

Race and Gender in Ophthalmology: A National Analysis of Medical Students with Intention to Pursue the Field.

Purpose The field of ophthalmology must become more reflective of the increasingly diverse U.S. population. This study characterizes students intending to pursue ophthalmology and practice in an underserved area versus other surgical and nonsurgical fields. Subjects Deidentified responses from 92,080 U.S. MD students who matriculated in the academic years beginning from 2007 to 2011 were obtained from the Association of American Medical Colleges (AAMC) Graduation Questionnaires. Methods Study participants were those who fully completed the AAMC Graduation Questionnaire. Chi-squared and multivariate logistical regressions were used for analyses. Results Ophthalmology intending graduates (OIG; n = 1,177) compared with other surgical intending graduates ( n = 7,955) were more likely to be female (adjusted odds ratio [aOR]: 1.46; 95% confidence interval [CI]: 1.28-1.66), Asian (1.71 [1.46-2.01]), and have conducted a research project with a faculty member (1.58 [1.26-1.98]). OIG compared with nonsurgery intending graduates ( n = 35,865) were more likely to have completed a research project with a faculty member (4.78 [3.86-5.92]), to be Asian (1.4 [1.21-1.62]), and have received scholarships (1.18 [1.04-1.34]). OIG were less likely to be female (0.64 [0.57-0.73]) and Black/African American (0.5 [0.33-0.74]). Among OIG, Black/African American students and multiracial students were more likely than non-Hispanic (NH) White students to report intention to practice in underserved areas (IPUA; 14.29 [1.82-111.88] and 2.5 [1.06-5.92]), respectively. OIG with global health experience were more likely to report IPUA (1.64 [1.2-2.25]). Conclusion Females and underrepresented in medicine (URM), respectively, were more likely to be nonsurgery intending graduates than OIG, which, if not addressed, may lead to a persistent underrepresentation of these groups in the field. In addition, URM students, including African American students, were more likely to report IPUA, which further emphasizes the importance of more URM students entering the field to address these growing gaps in medical care. Finally, we recommend increased mentorship to help address these disparities.

Demographic Factors and Medical School Experiences Associated with Students' Intention to Pursue Orthopaedic Surgery and Practice in Underserved Areas.

We analyzed deidentified data of AAMC Graduation Questionnaire respondents who matriculated between 2007 to 2008 and 2011 to 2012. Forty-eight thousand ninety-six (83.91%) had complete demographic, financial, and medical school elective data and were included in the study cohort. Multivariable logistic regression was performed to determine the correlation between student characteristics and intention to pursue orthopaedic surgery and IPUAs. Of the 48,096 students with complete information, 2,517 (5.2%) intended to pursue a career in orthopaedic surgery. Among the orthopaedic students, men were less likely than women to report IPUAs (adjusted odds ratio [aOR], 0.6; 95% CI, 0.4-0.8). Students who identified as Black/African American (aOR, 5.0; 95% CI, 3.0-8.2) or Hispanic (aOR, 2.0; 95% CI, 1.1-3.5) were more likely than White students to report IPUAs. Medical students who intend to pursue orthopaedics and received a scholarship (aOR, 1.5; 95% CI, 1.1-2.0), participated in community research (aOR, 1.8; 95% CI, 1.4-2.3), or had a global health experience (aOR, 1.9; 95% CI, 1.5-2.5) were more likely to report IPUAs. If orthopaedic surgeons who reported as medical students who reported IPUAs actually do so, recruiting and retaining more sex and race/ethnically diverse orthopaedic surgeons could reduce the impact of the impending shortage of orthopaedic surgeons in underserved areas. IPUA is correlated to medical school experiences related to cultural competency including global health experiences and community-based research projects.

Characterizing the geographic distribution of vascular surgeons in the United States.

The shortage of vascular surgeons can be attributed to multiple factors, including an aging population, the increasing demand for vascular surgeons, and an aging vascular surgery workforce. The distribution of vascular surgeons across the United States varies by locale; thus, the shortage affects regions of different sizes disproportionately. We collated the geographic data to characterize the current distribution of vascular surgeons with an emphasis on the practice location, population density, and population age. Vascular surgeons were identified using the Physician Compare National Downloadable file from the Centers for Medicare and Medical Services. The counties were matched with each surgeon's practice location. The locations were categorized into metropolitan, urban, or rural using the rural-urban continuum codes. Census Bureau data were used to match all counties with their population-level metrics. The distribution of vascular surgeons was analyzed by comparing the number of counties served, total patient population served, and patient population aged >50 and >65years served. Finally, the density of vascular surgeons in the United States for the total population and for those aged >50 and >65years was calculated. In 2018, the U.S. population was 309.8 million, and there were 3145 counties. Of the 3145 counties, 533 (17%) had had a practicing vascular surgeon. The combined population of these counties was 213.8 million people (69% of the U.S. population). Stratified by age, the vascular surgeons in these 533 counties could treat 37.3 million people aged >50years and 17.4 million people aged >65years. However, 2612 counties (83%), with a total population of 96 million people (31% of the U.S. population), had had no practicing vascular surgeon. When stratified by age, 78.1 million people in the uncovered counties were aged >50years and 35 million were aged >65years. Of the 2612 uncovered counties, 48% were urban and 24% were rural. We found a nationwide shortage of vascular surgeons, with urban and rural areas disproportionately affected negatively. Although encouraging vascular surgeons to practice in underserved areas would be an ideal solution, it is not pragmatic. Therefore, developing alternatives such as using primary care providers, investing in telehealth and developing transfer systems could be viable methods of providing vascular care to geographically isolated populations. These findings have significant implications for hospitals, patients, and vascular surgeons, who would all stand to benefit from efforts to address these disparities.

Diversity and Career Goals of Graduating Allopathic Medical Students Pursuing Careers in Dermatology

Dermatology is one of the least diverse specialties, while patients from minority racial and ethnic groups and other underserved populations continue to face numerous dermatology-specific health and health care access disparities in the US. To examine the demographic characteristics and intended career goals of graduating US allopathic medical students pursuing careers in dermatology compared with those pursuing other specialties and whether these differ by sex, race and ethnicity, and/or sexual orientation. This secondary analysis of a repeated cross-sectional study included 58 077 graduating allopathic medical students using data from the 2016 to 2019 Association of American Medical Colleges Graduation Questionnaires. The proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology vs pursuing other specialties. The proportions and multivariable-adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties and by sex, race and ethnicity, and sexual orientation among students pursuing dermatology. A total of 58 077 graduating students were included, with 28 489 (49.0%) female students, 8447 (14.5%) URM students, and 3641 (6.3%) SM students. Female students pursuing dermatology were less likely than female students pursuing other specialties to identify as URM (96 of 829 [11.6%] vs 4760 of 27 660 [17.2%]; P < .001) or SM (16 [1.9%] vs 1564 [5.7%]; P < .001). In multivariable-adjusted analyses, students pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (247 of 1350 [18.3%] vs 19 142 of 56 343 [34.0%]; adjusted odd ratio [aOR], 0.40; 95% CI, 0.35-0.47; P < .001), practice in underserved areas (172 [12.7%] vs 14 570 [25.9%]; aOR, 0.40; 95% CI, 0.34-0.47; P < .001), and practice public health (230 [17.0%] vs 17 028 [30.2%]; aOR, 0.44; 95% CI, 0.38-0.51; P < .001) but increased odds of pursuing research (874 [64.7%] vs 29 121 [51.7%]; aOR, 1.76; 95% CI, 1.57-1.97; P < .001) in their careers. Among students pursuing dermatology, female, URM, and SM identities were independently associated with increased odds of caring for underserved populations (eg, URM: aOR, 4.05; 95% CI, 2.83-5.80) and practicing public health (eg, SM: aOR, 2.55; 95% CI, 1.51-4.31). URM students compared with non-URM students pursuing dermatology had increased odds of intending to practice in underserved areas (aOR, 3.93; 95% CI, 2.66-5.80), and SM students compared with heterosexual students pursuing dermatology had increased odds of intending to become medical school faculty (aOR, 1.60; 95% CI, 1.01-2.57), to pursue administrative roles (aOR, 1.60; 95% CI, 1.01-2.59), and to conduct research (aOR, 1.73; 95% CI, 1.01-2.98). The findings of this cross-sectional study suggest that diversity gaps continue to exist in the dermatology workforce pipeline. Efforts are needed to increase racial and ethnic and sexual orientation diversity and interest in careers focused on underserved care and public health among students pursuing dermatology.

Factors Associated with Office-Based, Primary-Care Practice Among U.S. Medical Graduates: A National Cohort Study.

Purpose: Primary care (PC) career choice has been declining among U.S. medical graduates and residents since the 1990s. 1,2 By 2034, an estimated shortage of 17,800–48,000 PC physicians is expected. 2 Some medical schools have developed programs to increase students’ interest in PC specialties and practice in underserved areas. 3,4 To our knowledge, the durability of early PC-specialty preference for long-term PC practice has not been reported. Method: The Association of American Medical Colleges provided linked, deidentified data for a national cohort of 48,533 U.S. MD-granting medical school matriculants from 1998–1999 through 2000–2001. Data from the Student Records System (sex, race/ethnicity, and graduation year), Matriculating Student Questionnaire (MSQ; specialty board certification plans and attitudinal variables: importance of prestige and social responsibility in choosing a medical career), Graduation Questionnaire (GQ; total debt, plans to practice in underserved areas, and student ratings [excellent vs not excellent] of PC and non-PC clerkship experiences), and American Medical Association (AMA) Physician Masterfile practice data through May 2020 were used. The outcome was office-based practice in a specialty from the AMA Physician Masterfile, categorized as follows: (1) general-PC (i.e., internal medicine, pediatrics, family practice, general practice, internal medicine/pediatrics, or internal medicine/family practice as primary specialty, with another general-PC or unspecified secondary specialty), (2) PC-subspecialty (i.e., general-PC primary and PC-subspecialty secondary specialty, or PC-subspecialty as primary specialty), and (3) non-PC specialties (i.e., non-PC primary specialty). Multivariable logistic regression models identified variables independently associated with general-PC vs each of PC-subspecialty and non-PC-specialty practice. Results: Of 46,698 graduates in 2002–2013, 30,435 (65.2%) had complete data for analysis (7,700 [25.3%] general-PC physicians, 5,327 [17.5%] PC subspecialists, and 17,408 [57.2%] non-PC specialists). Female (vs male) students, and students with plans to practice in underserved areas (vs no plans) were more likely to report general-PC (vs PC-subspecialty) practice. Underrepresented racial/ethnic minorities in medicine (URiM), Asian/Pacific Islander (Asian/PI) students (each vs White), and students planning to pursue non-PC specialties or no board certification (each vs PC board certification plans) on the MSQ were each less likely to report general-PC (vs PC-subspecialty) practice. In the second model, female students and students reporting plans to practice in underserved areas (vs no plans), endorsing higher importance of social responsibility, or rating only PC clerkships excellent (vs rating both PC and non-PC clerkships excellent) were each more likely to report general-PC (vs non-PC-specialty) practice. URiM, Asian/PI students, students planning to pursue non-PC or no board certification, and students endorsing higher importance of prestige were each less likely to report general-PC (vs non-PC-specialty) practice. Discussion: Several factors were associated with future PC practice. The greater likelihood of women and lower likelihood of URiM graduating students to choose PC specialties on the GQ has been reported. 1 We extend this work, finding lower likelihood of URiM and A/PI physicians to be in general-PC practice. Importantly, early preference for PC specialties was positively associated with general-PC practice in both models. This may reassure medical schools considering early specialty preferences for admissions or entry into early, PC-pathway programs. Although clerkship experiences might influence students to change specialty interests, 5 to our knowledge, associations between clerkship experiences and PC practice have not been examined. We observed that students reporting excellent PC-clerkship experiences were more likely to report general-PC (vs non-PC) practice. Greater importance of social responsibility in choosing medicine also was positively associated with general-PC (vs non-PC) practice. Significance: Medical school experiences that are amenable to intervention were associated with greater odds of general-PC practice. Admitting students with early interest in PC specialties or who highly value social responsibility, fostering students’ plans to practice in underserved areas, 3,4 and improving PC-clerkship experiences may help mitigate the PC-physician shortage. Acknowledgments: The authors thank Hershel Alexander, PhD, Marie Caulfield, PhD (retired), David Matthew, PhD, and Lindsay Roskovensky, at the Association of American Medical Colleges (AAMC), for their efforts to obtain and prepare the deidentified datasets from various sources and their assistance with data coding; the National Board of Medical Examiners (NBME) Office for Research Strategy for permission to use Step 1 licensing examination data; Kristy Vanderplow at MMS, Inc., for provision of the American Medical Association (AMA) Physician Masterfile data; and Maria Pérez, MA, at Washington University School of Medicine, for data management and preparation of the data for analysis.

Pharmacy deserts and COVID-19 risk at the census tract level in the State of Washington

Community pharmacies are a crucial component of healthcare infrastructure, including for COVID-19 pandemic prevention services like testing and vaccination. Communities that are “pharmacy deserts,” experience healthcare inequities. However, little research has characterized where these communities are, making it difficult for local leaders to prioritize resources for them. This study identifies pharmacy deserts at the census tract level in Washington state for the first time and explores their association with COVID-19 risk. Out of 1,441 tracts, 127 were pharmacy deserts, comprising approximately 454,000 adults, or 8% of the state’s adult population. Among those tracts identified as pharmacy deserts, 67% were considered high risk for COVID-19. Solutions are needed to expand equitable access to pharmacy services in these communities. The methods and data presented herein provide healthcare leaders with information to address this pharmacy access gap in Washington and could be similarly applied to other settings. Three categories of policy changes could address health inequities found in our study: 1) improve financial incentives for pharmacists to practice in underserved areas, 2) prevent pharmacy closures, and 3) deploy innovative care delivery methods such as telehealth services.

Dental school pathway programs: Best practices for increasing workforce diversity.

The chronic underrepresentation of racial/ethnic minority practitioners in the U.S. health professions workforce is an oft-cited factor for disparities in health and health-care access affecting communities of color. As non-White providers are more likely to serve uninsured patients and practice in underserved areas, pathway/pipeline programs have been used for many years to increase the numbers racial/ethnic minorities in the health professions workforce. These programs target precollege, college, and postbaccalaureate students from historically underrepresented minority (HURM) groups (defined as African American/Black, Hispanic/Latino, and Native American students) to stimulate interest in health professions careers and provide academic support, mentoring, enrichment experiences, and other resources to facilitate their successful admission to and completion of health professions school and entry into the workforce. This article examines dental pathway programs to identify best practices for increasing enrollment of HURM students in dental school and their successful entry into the dental workforce-as evidenced in the academic literature.

Understanding the Experiences of American Indian and Alaska Native Students Enrolled in Allopathic and Osteopathic Medical Degree Programs.

Despite a growing population, American Indian and Alaska Native (AI/AN) students have seen no meaningful increase in representation in allopathic and osteopathic medical degree programs. While AI/AN medical students are more likely to practice in underserved areas, they face financial and sociocultural obstacles towards doing so. This underscores the need to understand the experiences of these trainees, and identify barriers and facilitators to the successful recruitment, retention, and advancement of AI/AN trainees. A survey was administered to members of the Association of Native American Medical Students (ANAMS), an organization representing self-identified Native medical students. This survey elicited demographic information, opinions of institutional climate, and aspects of academic and social experiences during medical school. There were n = 39 complete responses. Over fifty percent of respondents (n = 21) identified as AI/AN alone and not in combination with another racial or ethnic group. Overall, respondents were: Generally, not satisfied with their school's engagement with Native communities and AI/AN health curricula. Likely to report barriers towards their timely advancement in training, namely being a first-generation or low income student, and feelings of imposter syndrome. Likely to report an interest to work in primary care fields and serve AI/AN communities in the future. This survey identified several barriers to successful AI/AN medical trainee advancement, highlighting opportunities for institutions to foster inclusion of AI/AN trainees and grow the number of Native physicians.

Characteristics of graduating medical students interested in neurosurgery with intention to practice in underserved areas: Implications for residency programs

ObjectiveIt is of paramount importance that the United States (U.S.) physician and surgical workforce reflects its changing population demographics. The authors characterized factors contributing to graduating medical students’ decision to pursue a residency in Neurosurgery to assess opportunities for recruitment and retainment of graduates interested in working with underserved populations. MethodsData from the Association of American Medical Colleges (AAMC) Student Record System (SRS), and the AAMC Graduation Questionnaire (GQ) were collected on a national cohort of U.S. medical students from 2012 through 2017. Data including self-reported sex, race/ethnicity, age at matriculation, degree program, intention to practice in underserved area, total debt, scholarships, volunteer activities and medical electives was analyzed using chi-squared tests and multivariate logistic regression models. ResultsThe study included 48,096 graduating medical students surveyed by GQ and SRS, 607 (1.26%) of whom reported an intention to pursue Neurosurgery (Neurosurgery cohort). Compared to students pursuing other specialties, the Neurosurgery cohort had fewer students identify as female (18.95% vs. 48.18%, p < 0.001), and report an intention to work with underserved populations (11.37% vs. 26.37%, p < 0.001). In addition, Black/African-American students were significantly more like to indicate intention to pursue Neurosurgery compared to White students (aOR=1.51, 95% CI:1.01–2.24). Moreover, within the Neurosurgery cohort, Black/African-American (aOR=7.66, 95% CI:2.87–20.45), Hispanic (aOR=4.50, 95% CI:1.40–14.51) and female students (aOR=2.44, 95% CI:1.16–5.12) were more likely to report an intention to practice in underserved urban and rural areas, compared to their peers. ConclusionsOur study identified several key demographic and academic factors influencing intention to pursue a neurosurgical career, and work with underserved populations. Our data provides an opportunity for further discussions on the residency selection process and seeks to empower residency programs to diversify the neurosurgical workforce, tackle health disparities and improve patient care for the entire US population.

Incentive Programs for Physicians to Practice in Underserved Areas: A Nationwide Snapshot.

Access to health care is limited in part by maldistribution of physicians. Physicians agreeing to work in underserved areas can receive a financial incentive or a visa waiver that eases immigration restrictions. However, the overall landscape and scale of incentive programs and providers remains unelucidated. This article aggregates the reported output of state and federal programs and assesses their relative contributions to increasing the physician workforce in underserved areas. The estimates derived suggest that in 2017 the National Health Service Corps supported placement of around 2000 physicians, fully state-funded financial incentive programs about 1000, and visa waiver programs over 3500.

Geographic practice preferences of graduating medical students pursuing careers in dermatology

Geographic practice preferences of graduating medical students pursuing careers in dermatology

A Mixed-Methods Study of Teaching Health Center Residents' Experiences of Mentorship, Career Planning, and Postresidency Practice Environments.

The Teaching Health Center (THC) Graduate Medical Education program enables primary care physicians to train in community-based, underserved settings by shifting the payment structure and training environment for graduate medical education. To understand how THCs have successfully trained primary care physicians who practice in community-based settings, the authors conducted a mixed-methods exploratory study to examine THC residency graduates' experiences of mentorship and career planning during their residencies, perceptions of preparation for postresidency practice, and how these experiences were related to postresidency practice environments. Surveys were conducted for all 804 graduating THC residents nationally, 2014-2017 (533 respondents, 66% response rate). Three quantitative outcomes were measured: graduates' perceptions of preparation for practice after residency (Likert scale), satisfaction with mentorship and career planning (Likert scale), and characteristics of postresidency practice environment (open-ended). A qualitative analysis of open-text survey answers, using thematic content analysis, was also conducted. Most THC graduates (68%) were satisfied with their mentorship and career planning experience and generally felt prepared for postresidency practice in multiple settings (78%-93%). Of the 533 THC graduates who provided information about their practice environment, 445 (84%) were practicing in primary care; nationally, 64% of physicians who completed primary care residencies practiced in primary care. Of the 445 THC graduates practicing in primary care, 12% practiced in rural areas, compared with 7% of all physicians. Just over half of THC graduates (51%) practiced in medically underserved areas, compared with 39% of all physicians. This study offers early evidence that the THC model produces and retains primary care physicians who are well prepared to practice in underserved areas. Given these promising findings, there appears to be a substantial benefit to growing the THC program. However, the program continues to face uncertainty around ongoing, stable funding.

Supporting youth mental health during the COVID-19 pandemic.

Supporting youth mental health during the COVID-19 pandemic.

Association of Demographic Factors and Medical School Experiences With Students’ Intention to Pursue a Surgical Specialty and Practice in Underserved Areas

The surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students' intention to practice in underserved areas is unknown. To evaluate the association between students' demographics and medical school experiences with intention to pursue surgery and practice in underserved areas. This cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020. Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students' intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas. Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ2 P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas. This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students' motivation to practice in underserved areas.