Choosing primary care as a profession: A systematic review

Abstract

McKinley Thomas, Jeff Jones

The importance of primary care as a means toward individual and community health is unchallenged. However, with the number of primary care physicians entering the field on the decline in the United States, a clear view of the career pipeline becomes crucial, especially with regard to the role of medical education. The literature posits a number of predictive variables as important determinants of career selection. Much of the research focused on career decisions that are based upon preclinical ideation rather than occupational outcomes. We conducted a synthesis of the literature to explore factors most influential when selecting primary care as a profession. CINAHL, Web of Science, Ovid MEDLINE, and PubMed MEDLINE were explored from January 2008 to December 2017 to identify salient factors associated with a career decision to follow a primary care pathway. This review yielded 226 publications with 27 meeting our inclusion and quality criteria. Our analysis generated five overarching categories that best represent salient influences toward primary care as a career: general academic experiences, pipeline programs, student debt, characteristics of the educational institution, and student characteristics. We found that career decisions toward primary care were best supported by sound medical educational practice, remunerative expectations, and individual qualities such as familial background and preferred lifestyle. Our findings are congruent with earlier analyses in that academic experiences play an important role in career development toward primary care. However, our study did not capture rural experiences or demographic factors, both reported in previous studies in which preclinical students were queried. For medical educators, administrators, and students themselves, these outcomes represent largely modifiable factors when addressing the looming physician shortage.