Comparisons between older and usual-aged medical school graduates on the factors influencing their choices of primary care specialties

Purpose. To examine whether there are differences between older (30+ years) and usual-aged graduates in the factors that influence their decisions to enter primary care. Method. A national survey of primary care physicians was conducted by mail in early 1993. The survey population comprised physicians who had graduated from U.S. allopathic medical schools in 1983 and 1984. The questionnaire consisted of four parts: practice characteristics, 19 variables influencing the physicians' decisions to enter primary care (rated on a scale from 5 = very strong influence to 1 = no influence), the timing of the decision to enter primary care, and demographic and personal information. Data were analyzed through several statistical methods. Results. In all, 355 (22%) older and 1,241 (78%) usual-aged graduates who were practicing in primary care specialties responded. Compared with the usual-aged graduates, the older graduates were more likely to have grown up in rural or inner-city areas, to have obtained a second academic degree, and to have made the decision to enter primary care earlier. The older graduates' decisions to enter primary care had been more influenced by children and familial responsibilities, whereas the usual-aged graduates had been more influenced by internship and residency experiences and by parents and role models before medical school. Conclusion. This study provides empirical evidence to support the notion that nontraditional students (i.e., older ones) are more likely to commit themselves earlier to a career decision and less likely to be influenced by the socialization process during medical school. In this regard, age-specific factors should receive more attention in the analysis of the physician workforce.