Understanding the Relative Importance and Monetary Value of Factors That Influence U.S. Medical Students' Career Choices

• In Event: Contextual Determinants of Choice and Access to Medical Studies: An International Perspective

Abstract

Objectives

This paper addresses a key challenge in the US healthcare system, the shortage of physicians in key medical specialties and geographies, by extending our knowledge of how students in medical school make career decisions. The purpose is to understand the relative importance and the monetary value of eight attributes of careers in medicine and their relationship with career decisions made by US allopathic medical school students at the time of residency selection.

Theoretical Framework

This study is guided by a conceptual framework that draws from theories of consumer choice (Ben-Akiva et al., 2012; McFadden, 2001) and social cognitive behavior (Bandura, 1986; Lent & Brown, 1996) applied to career-related decisions of US medical students. The literature review identifies seven categories and more than 50 factors overall that have been shown to be related to medical career decisions in prior studies (see, for example, Bland, Meurer, & Maldonado, 1995; Querido et al., 2016).

Data and Methods

Third and fourth-year students at three US allopathic medical schools were invited to complete an online survey consisting of 43 questions including a discrete choice experiment. The discrete choice experiment presented twelve pairs of career alternatives, each described by a combination of the eight career attributes. Students were asked to select their preferred career in each pair. In total, 68 respondents completed the survey and provided a total of 1,632 choice observations. The resulting data was analyzed using a random parameter mixed logit model of career choice, supplemented by lasso regularized regression methods to further examine the relationship between career choice and compensation expectations.

Results

The factors that influence medical students’ career decision-making include preference for specialty, geography, and patient variety, frequency of patient contact, compensation, prestige, the opinion of others, and personal competitiveness for subsequent training. Compensation, the opinion of others, geography of practice, and specialty are the most important factors, and students value them each at 25% to 47% of expected compensation. Mean expected compensation among the sample was $264,700. After controlling for other differences, female medical students expect to make $75,000 less than males, and students who prefer primary care specialties expect to make $62,000 less than non-primary care. Students who grew up in suburban areas expect to make $65,000 more than students from rural or urban areas. While higher compensation is attractive to students, increasing it through financial incentives such as scholarships or debt repayment showed minimal probability of altering career decisions concerning medical specialty and geography of practice.

Significance

This study proposes and begins to test a comprehensive conceptual framework for medical career decision-making, deepens our understanding of the process by which medical students make career decisions and the factors that are related to such decisions, and provides insight into the opportunities and challenges of using financial incentives to influence students’ career choices.

Author

• Marc Louis Ruggiano, University of Virginia