Choosing Primary Care: Factors Influencing Graduating Osteopathic Medical Students.

CONTEXT: Access to primary care (PC) improves health outcomes and decreases health care costs. The shortage of PC physicians and shifting physician workforce makes this an ongoing concern. Osteopathic medical schools are making strides to fill this void. Considering the critical need for PC physicians in the United States, this study aims to identify factors related to choosing a PC specialty. OBJECTIVE: To understand possible motivations of osteopathic medical students pursuing a career in PC specialties by examining the role of sex and the influence of 5 key factors in this decision. METHODS: Responses from the annual American Association of Colleges of Osteopathic Medicine graduate survey (2007-2016) were analyzed. Self-reported practice decision considerations of 5 key factors, including (1) intellectual and technical content, (2) debt level, (3) lifestyle, (4) prestige/income level, and (5) personal experience and abilities were summarized, and their subjective value was contrasted between osteopathic medicine graduates pursuing PC specialties vs those pursuing non-PC specialties. RESULTS: The mean percentage of graduates pursuing PC and non-PC specialties from 2007 to 2016 was 31.3% and 68.7%, respectively. Women were 1.75 times more likely to choose PC than men (95% CI, 1.62-1.89). Regardless of specialty choice, lifestyle was the most important factor each year (1027 for PC [75.3%] vs 320 for non-PC [63.3%] in 2016; P<.0001). Students entering PC were more likely to report prestige and income level to be "no or minor influence" compared with students entering non-PC specialties (P<.0001). Debt level was more likely to be a "major influence" to students choosing to enter non-PC specialties than to those entering PC (P<.0001), and the percentage of non-PC students has grown from 383 in 2007 (22.9%) to 833 in 2016 (30.6%). CONCLUSION: Sex was found to significantly influence a graduate's choice of specialty, and female graduates were more likely to enter practice in PC. Each of the 5 survey factors analyzed was significantly different between students entering PC and students entering non-PC specialties. Lifestyle was deemed a major influencing factor, and responses suggested that debt level is a strong influencing factor among students pursuing non-PC specialties.

Measuring awareness, interest, and involvement in the osteopathic community through board certification: a survey of DO residents in ACGME-accredited training programs.

Currently, close to 50% of osteopathic medical graduates receive residency training from programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) rather than those approved by the American Osteopathic Association (AOA). As a result, leaders within the osteopathic medical profession have expressed ongoing concerns about the viability of the profession's distinct osteopathic identity. Using a one-page, 12-item survey, the authors queried ACGME-trained family practice residents (N=1354) regarding their interest in formal membership, continuing medical education activities, and specialty board certification options within the osteopathic medical profession. Four hundred twenty-six completed surveys were returned and usable for analysis for an overall response rate of 31.4%. A majority of survey participants indicated an interest "in continuing [their] osteopathic skills and training during residency" (376 [88.5%]), membership in osteopathic organizations and participating in continuing medical education programs (325 [77.2%]), and completing the American Osteopathic Board of Family Physicians certification examination (267 [63.7%]). Unfortunately, actual involvement may be limited by lack of communication or understanding, as in the case of lack of awareness regarding eligibility criteria for AOA board certification (311 [74.2%]). A variety of recommendations are offered to osteopathic organizations to improve involvement in and commitment to the profession among ACGME-trained DOs.