Factors affecting specialty choice among osteopathic medical students.

PURPOSE: The availability of primary care directly and favorable affects the health status of local communities. This study shows the predictors and characteristics of osteopathic medical students who chose a primary care specialty (PCS). METHOD: The authors surveyed 2,345 fourth-year osteopathic medical students during 2003-2004. A total of 1,882 (80%) responded. By means of their survey, the authors examined many aspects of the students' experiences and other factors in relation to choice of a PCS versus a nonprimary nonsurgical specialty (NPCS) and compared their findings against findings in the allopathic specialty-choice literature. RESULTS: Dealing with people was favored by those entering a PCS, whereas the NPCS group cited technical skills, prestige and income, and lifestyle as being highly influential. Both PCS and NPCS respondents favored dually accredited programs (American Osteopathic Association-Accreditation Council for Graduate Medical Education). Women showed a slightly greater preference for a PCS, whereas men overwhelmingly chose an NPCS. Those who anticipated practicing in cities of fewer than 100,000 citizens tended to choose a PCS. Those individuals choosing a PCS expect their income to be less than those choosing an NPCS. Debt showed a monotonic influence on specialty choice, with respondents who had greater debt favoring NPCSs. CONCLUSIONS: No single factor reliably predicts specialty choice; it is a complex decision-making process. There are modifiable factors (debt) and nonmodifiable factors (gender) that influence specialty choice. The study's findings suggest that positively influencing the modifiable risk factors will increase the probability but not the certainty of osteopathic medical students' choosing a PCS.

Sources of payment for assistive technology: findings from a national survey of persons with disabilities.

This article provides an overview of who pays for the most commonly used assistive technology devices, special adaptations, and environmental accommodations by persons with disabilities in the United States. The latest findings from the 2001 survey of Use and Need of Assistive Technology and Information Technology by Persons With Disabilities in the United States conducted by the National Institute on Disability and Rehabilitation Research, Rehabilitation Engineering and Assistive Technology Society of North America, and the University of Michigan will be presented and compared to findings from earlier research and reviews of the literature. A modified discriminant function analysis was performed to determine the interaction between the source of payment for assistive technology used by persons with disabilities. In the sample of 1,414 such persons, 901 were found to use some form of assistive technology in their daily lives. Ten distinct sources of payment were specified. Respondents were able to mention up to three sources of payment for each example of assistive technology used. A total of 1,877 sources were mentioned. Overall, the most mentioned payment source was self or other family member in household, accounting for nearly 40% of all sources mentioned. The variables tested were found to have varying levels of interactive potency. Occupational status, education level, severity of impairment, opinion as to the effectiveness of assistive technology, and personal income were significant, whereas age, family income, opinion as to improvement over the past decade, and race were statistically unrelated to source of payment. From the perspective of relative discrimination on the basis of payment source, Medicare stands as the lone significant discriminant source of payment. The authors offer a summary and conclusion based on an integrated view of all available sources of information about payment.