Interest in Primary and Underserved Care Among Minority and Rural Medical Students

Jennifer Edwards-Johnson, DOPrincipal Investigator: Jennifer Edwards-Johnson, DO, Assistant Professor Sparrow-MSU Family Health Center (MSU)

Co-Investigators:
Julie Phillips, MD, MPH Associate Professor; Assistant Dean for Student Career and Professional Development
Andrea Wendling, MD Associate Professor; Director of Rural Medicine Curriculum
James Olson, MD Associate Professor; Director, Sparrow-MSU Family Medicine Residency Program
Project Faculty:
Julia Terhune, MA Educational Specialist; Assistant Director Rural Community Health
Iris Kovar-Gough, MLIS Liaison Librarian to the College of Human Medicine

Purpose: To examine the evolution of interest in primary and underserved care from matriculation to graduation and compare to eventual practice location in rural or underserved communities for a 19-year cohort of Michigan State University College of Human Medicine students.  Outcomes will be compared by race, ethnicity, rural origin and gender.
Specific Aims: 1) Identify and describe those graduates interested in primary care careers as first year students and compare to eventual specialty to determine changing interest, describing trends based on student demographics; 2) describe how changing interest impacts interest in other specialties; 3) examine changing interest in caring for underserved populations from matriculation to practice; and 4) visually demonstrate the contribution of rural and underrepresented minority (URM) groups on care of urban and rural communities of Michigan and compare with all other MSU-CHM graduates.
Innovations: Study is the first to examine evolution of primary care interest in URM and rural medical students, and uses innovative merging of datasets and geomapping to visually represent findings.
Rationale/Study Significance: URM and rural medical students are more likely to enter primary care and treat underserved populations.1,8,17, 28-30 Physicians from diverse backgrounds also foster high-trust patient-physician relationships which improve satisfaction and adherence to treatment.2,3 Among U.S. medical students, there is a decline in interest in primary care and underserved care during medical school.4,5 It is unknown, however, whether this decline is different for URM and rural students than for other students. This has implications for the current primary care shortage, as educational programing (such as clinical experiences within underserved communities), if timed appropriately, could potentially bolster the entrance of students into the primary and underserved care workforce.
Approach/Design/Sample/Methods: We propose a retrospective study using reliable datasets to assess how primary and underserved care interest changes among URM and rural students. We will compile a merged dataset of MSU-CHM graduates from 1991-2010, using Association of American Medical Colleges questionnaires assessing future career interest administered to all first-year and graduating medical students; American Medical Association Physician Masterfile data, which includes specialty and 2015 practice location for MSU-CHM graduates; and internal MSU-CHM data, including student demographics. We will use publicly available Health Profession Shortage Area data to determine which graduates currently practice in shortage areas and Rural Urban Commuting Area data to define rural communities. Geomapping will be used to map graduates’ current practice sites, demonstrating impact of URM and rural graduates on specific urban and rural regions. Descriptive statistics, chi square analyses and logistic regression will be used to compare data and control for variables known to impact specialty choice. Results will allow researchers to identify areas of potential action and develop targeted solutions for retaining URM and rural students in primary and underserved care, improving health outcomes 6 and decreasing costs7,8 for vulnerable populations.
Future Funding: We anticipate support from the AAFP Foundation for expansion of this study to other medical schools. We then anticipate applying for an R21 grant to fund the purchase and analysis of a complete dataset of all US medical colleges.