AMSA's 2015 Annual Convention
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February 26 - March 1, 2015 

The AMSA Foundation’s Fifth Annual Primary Care Scorecard

The New Physician April 2000
As we begin the 21st century, medical education faces a dilemma as well as an opportunity. The dilemma is not new. There’s a shortage of physicians entering or planning to enter generalist specialties. One probable reason behind this is the number of students who change their minds during medical school about pursuing primary care careers. The opportunity lies in what medical schools can do to encourage students to maintain their commitment to primary care specialties.


According to the Association of American Medical Colleges, in 1992, 14.6 percent of graduating students surveyed stated that they planned to pursue careers in one of the generalist specialties, but no school graduated 50 percent or more students with generalist intentions and only one school reached 40 percent. In 1995, 27.5 percent planned on pursuing careers in one of the generalist specialties, five schools graduated more than 50 percent and another 15 graduated more than 40 percent who favored generalist careers. In 1997, 39.6 percent
of fourth-year U.S. medical school students planned on entering generalist specialties.


Is it possible to identify what types of factors influence students to choose primary care as a specialty? More importantly, what influences students to switch from primary care to another specialty? Several surveys—including an informal one conducted as part of the American Medical Student Association’s (AMSA’s) Promoting, Reinforcing and Improving Medical Education (PRIME) project—reveal some of the major factors influencing students’ specialty choices.


Personal characteristics. Choosing a specialty is a personal decision based, in part, on an individual’s values and disposition. Recent studies suggest that medical student characteristics that are common among graduates entering generalist careers include initial specialty preference, geographic background, gender, age, ethnicity, economic and lifestyle factors, attitudes and personal values, service orientation and premedical academic performance. For example, older students, married students, women and those for whom high salaries are not as important are more likely to enter primary care, as are students who value a diverse patient population. Students who want to provide comprehensive care and develop personal relationships with their patients also tend to choose careers in primary care.


Monetary considerations. Studies have also found that income and monetary rewards are highly, but inversely, related to a generalist career choice. The debt incurred during medical training influences specialty decision. Currently, only 30 percent of graduating physicians enter lower-income primary care specialties, including family medicine, pediatrics and internal medicine. Having electives in primary care was another variable found to be associated strongly with students’ change of interest in primary care.


Time for family. Medical students entering primary care professions, especially in rural areas, are concerned about the effect personal and professional isolation will have on their spouses or families. Will there be work available for my spouse? What kind of education and opportunities will my children have? Moving away from extended family and friends can be an important consideration for some medical students.


However, many students view primary care specialties as less demanding of their personal time than other specialties with unpredictable hours, such as surgery and obstetrics–gynecology. These findings suggest there are ways to enhance medical school curricula so that more students pursue and enter primary care as their preferred specialty. The following suggestions may have an effect on the number of medical students who switch specialties.


Primary care electives. Increase the number and quality of primary care electives during third and fourth years. Does your school have a family medicine elective clerkship? Is the elective conducive to developing personal relationships with your patients? Is your preceptor also a personal mentor?


Loan repayment programs. Effectively disseminate information on programs in primary care that offer loan repayment in addition to salary, such as the National Health Service Corps. These programs can be an excellent way to experience the benefits of primary care with fewer concerns about financial considerations.


Mentoring. Create mentoring or precepting opportunities with community-based practitioners, beginning early in medical school and continuing as part of students’ clinical years.


Curriculum reform. Encourage innovative curriculum reform commitments that include a strong focus on primary care. Does your school have a service-learning track or spend time addressing issues in cultural competence? Are there opportunities to provide longitudinal care for patients?


The “AMSA Foundation’s Fifth Annual Primary Care Scorecard” focuses on one measurable aspect of medical education: the percentage of medical school graduates entering primary care residencies. Clearly, this is only one part of a larger effort to understand why so many students switch specialty choices between matriculation and graduation. The Primary Care Scorecard shows one end of the spectrum—specialty choice at graduation—and only by actively exploring what causes students to switch between matriculation and graduation can we affect future Primary Care Scorecards.


Meredith Burke Lawler is the AMSA Foundation’s PRIME project manager. Pam Supanwanid is a third-year medical student at Northwestern University in Chicago and a PRIME project intern. Additional assistance was provided by Lisa Old, PRIME project associate.


Percentage of 1999 Allopathic Medical School
Graduates Entering Primary Care Specialties































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































  Medical School %FP %IM %PEDS %IM/

PEDS
%PC

1

Univ of Illinois-Rockford 33.3 20.4 16.7 3.7 74.1
2 Morehouse school of medicine 27.6 24.1 13.8 3.4 68.9
3 albert einstein college of medicine 5.3 47.3 16.0 0.0 68.6
4 meharry medical college 25.9 24.7 12.3 4.9 67.8
5 SUNY-Stony brook 15.1 34.9 17.0 0.0 67.0
6 univ of washington 26.9 25.1 9.0 3.0 64.0 "Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:EN-US;
mso-bidi-language:AR-SA">†
7 mercer univ 25.5 25.5 10.9 1.8 63.7
8 univ of missouri-Kansas city 21.0 25.9 7.4 8.6 62.9
9 univ of california, los angeles 17.3 25.6 19.2 0.6 62.7"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:EN-US;
mso-bidi-language:AR-SA">*
10 wright state univ 31.3 19.8 9.4 2.1 62.6
11 univ of rochester 5.1 35.4 15.2 6.1 61.8
11 univ of south carolina 20.6 20.6 19.1 1.5 61.8
13 east carolina univ 34.3 8.6 10.0 8.6 61.5
13 univ of minnesota medical school 28.1 22.4 8.8 2.2 61.5 "Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:EN-US;
mso-bidi-language:AR-SA">°
15 michigan state univ 24.5 17.9 11.3 7.5 61.2
15 univ of hawaii 24.1 20.4 11.1 5.6 61.2
17 univ of vermont 8.4 25.3 24.2 3.2 61.1
18 southern illinois univ 21.1 28.2 5.6 5.6 60.5
19 eastern virginia  medical school 20.8 20.8 16.8 2.0 60.4
20 univ of south dakota 32.0 16.0 10.0 2.0 60.0
21 univ of kansas 27.4 17.7 9.7 5.1 59.9
22 medical college of georgia 19.9 25.7 13.5 0.6 59.7
23 univ of nevada 32.7 15.4 7.7 3.8 59.6
24 univ of chicago pritzker 3.6 36.9 18.0 0.9 59.4
25 northeastern ohio univ 17.5 35.0 5.8 0.0 58.3
26 MCP hahnemann univ 17.8 25.0 15.3 0.0 58.1
27 univ of massachusetts 17.9 25.3 13.7 1.1 58.0
28 rush medical college 14.3 31.7 9.5 2.4 57.9
29 oregon health sciences univ 25.0 23.1 8.7 1.0 57.8
30 east tennessee state univ 14.8 27.9 14.8 0.0 57.5
30 univ of texas-San antonio 22.7 20.2 13.6 1.0 57.5
32 univ of nebraska 21.8 23.6 9.1 2.7 57.2
33 univ of kentucky 18.3 24.7 6.5 7.5 57.0
34 univ of connecticut 6.8 27.3 18.2 4.5 56.8
35. univ of virginia 17.8 22.5 15.5 0.8 56.6
36 univ of pittsburgh 12.1 25.0 16.4 2.9 56.4
37 univ of south alabama 15.3 20.3 15.3 5.1 56.0
38 medical college of ohio 15.5 24.0 10.1 6.2 55.8
39 univ of california, san diego 11.5 26.9 14.4 2.9 55.7
40 univ of florida 14.5 24.8 16.2 0.0 55.5
41 georgetown univ 6.8 33.5 12.4 2.5 55.2
42 west virginia univ 20.7 20.7 7.3 6.1 54.8
43 univ of new mexico 25.8 18.2 9.1 1.5 54.6
44 univ of southern california 15.2 29.7 9.5 0.0 54.4
45 northwestern univ 6.4 36.8 11.1 0.0 54.3
46 univ of cincinnati 12.4 21.2 16.1 4.4 54.1
47 univ of alabama 14.5 21.1 14.5 3.6 53.7
47 univ of iowa 27.8 15.4 9.9 0.6 53.7
49 wake forest univ 12.7 26.4 12.7 1.8 53.6
50 ohio state univ 20.7 18.1 11.9 2.6 53.3
52 new york medical college 6.8 29.2 15.1 2.1 53.2
53 univ of california, san francisco 11.4 26.9 13.4 1.3 53.0
54 harvard medical school 2.5 35.2 12.6 2.5 52.8
54 univ of arizona 19.1 14.6 169 2.2 52.8
56 saint louis univ 14.9 16.9 15.5 5.4 52.7
57 howard univ 4.0 34.3 13.1 1.0 52.4`
57 tufts univ 9.6 26.5 14.5 1.8 52.4
57 univ of missouri-Columbia 19.8 12.8 14.0 5.8 52.4
60 loma linda univ 17.3 25.6 7.1 1.9 51.9
60 loyola univ - stritch 13.5 25.6 9.8 3.0 51.9
62 brown univ 14.1 27.1 8.2 2.4 51.8
64 jefferson medical college 19.8 18.0 12.9 0.5 51.2
65 wayne state univ 17.2 25.0 6.6 2.0 50.8
66 univ of mississippi 15.1 24.7 8.6 2.2 50.6
67 emory univ 7.5 29.0 14.0 0.0 50.5
67 univ of illinois-Chicago 8.8 26.9 13.2 1.6 50.5
69 univ of maryland 10.1 22.3 15.8 2.2 50.4
70 temple univ 8.2 27.7 13.0 1.1 50.0
70 texas a & m univ 16.1 11.3 16.1 6.5 50.0
70 VCU medical college of virginia 16.3 18.1 12.5 3.1 50.0
73 albany medical college 13.6 18.9 15.9 1.5 49.9
74 SUNY-Buffalo 11.3 18.4 16.3 3.5 49.5
75 univ of california, irvine 15.3 21.2 12.9 0.0 49.4
76 weill medical colelge-Cornell 1.0 37.8 10.2 0.0 49.0
77 marshall univ 25.5 6.4 10.6 6.4 48.9
78 mt sinai school of medicine 2.4 30.7 15.7 0.0 48.8
79 univ of oklahoma 18.8 14.6 13.2 2.1 48.7
80 ponce school of medicine 6.3 28.1 12.5 1.6 48.5
81 new york univ 1.9 33.5 12.4 0.6 48.4
82 univ of california, davis 12.0 20.7 15.2 0.0 47.9
84 univ of wisconsin 17.6 14.0 14.0 2.2 47.8
85 univ of colorado 16.7 21.2 9.8 0.0 47.7
86 louisiana state univ - new orleans 11.9 21.9 8.8 5.0 47.6
86 medical univ of south carolina 16.7 14.2 15.0 1.7 47.6
88 univ of illinois-Peoria 12.3 15.8 12.3 7.0 47.4
88 univ of miami 11.5 19.9 14.1 1.9 47.4
88 washington univ 5.1 25.4 16.9 0.0 47.4
91 univ of michigan 14.2 19.5 8.9 4.7 47.3
92 texas tech univ 24.8 12.8 9.6 0.0 47.2
93 medical college of wisconsin 14.8 18.4 11.7 2.0 46.9
94 george washington univ 10.3 21.8 14.7 0.0 46.8
95 univ of texas-Galveston 21.2 15.6 8.0 1.9 46.7
96 UMDNJ-Robert wood johnson 7.4 26.4 10.8 20.6 46.6"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language:EN-US;
mso-bidi-language:AR-SA">∞
97 univ of tennessee 12.7 22.4 6.1 4.8 46.0
98 columbia univ 0.7 31.7 13.1 0.0 45.5
99 univ of texas-Houston 15.3 14.3 10.2 5.6 45.4
100 finch univ/Chicago medical school 9.1 24.7 10.8 0.5 45.1
101 univ of north dakota 18.4 14.3 8.2 4.1 45.0
102 univ of north carolina-Chapel hill 10.4 18.7 14.2 1.5 44.8
102 vanderbilt univ 3.1 22.9 14.6 4.2 44.8
104 case western reserve univ 10.3 17.1 15.8 1.4 44.6
105 dartmouth medical school 17.5 12.7 14.3 0.0 44.5
106 johns hopkins univ 0.9 28.7 11.3 3.5 44.4
107 SUNY-Syracuse 12.9 23.8 6.1 1.4 44.2
108 uniformed services univ 16.8 16.1 11.2 0.0 44.1
109 univ of texas-Southwestern 6.2 31.1 6.2 0.5 44.0
110 boston univ 5.2 25.8 11.6 1.3 43.9
111 indiana univ 19.8 11.7 9.3 2.7 43.5
112 tulane univ 8.0 20.0 12.7 2.7 43.4
113 yale univ 2.2 26.1 13.0 1.1 42.4
114 SUNY-Brooklyn 2.7 23.2 15.1 1.1 42.1
115 pennsylvania state univ 13.3 16.2 11.4 1.0 41.9
115 UMDNJ-New jersey 5.2 22.1 9.9 4.7 41.9
117 baylor college of medicine 8.7 16.8 13.9 2.3 41.7
118 stanford univ 4.9 25.6 11.0 0.0 41.5
119 louisiana state univ-Shreveport 12.9 10.8 12.9 4.3 40.9
120 univ of louisville 13.3 12.5 8.6 6.3 40.7
121 univ of pennsylvania 2.2 22.5 13.8 1.4 39.9
122 univ of south florida 11.1 17.8 8.9 1.1 38.9
123 univ of illinois--Urbana-Champaign 16.0 8.0 8.0 4.0 36.0
124 duke univ 1.0 20.8 7.9 4.0 33.7
124 univ of puerto rico 8.0 18.6 6.2 0.9 33.7
126 mayo medical school 5.7 5.7 20.0 0.0 31.4

Unranked

- Universidad Central del Caribe -- no data submitted.




Percentage of 1998 Osteopathic Medical School
Graduates Entering Primary Care Specialties













































































































































































Medical School %FP %IM %PEDS %IM/

PEDS
%PC

1

chicago COM 88.4 5.3 2.1 0.0 95.8

2
UMDNJ SOM 66.7 20.6 7.9 0.0 95.2

3
michigan state univ COM 66.1 23.2 5.4 0.0 94.7

4
univ of new england COM 85.5 5.5 1.8 0.0 92.8

5
west virginia SOM 89.1 3.6 0.0 0.0 92.7

6
kirksville COM 81.2 9.4 1.7 0.0 92.3

7
philadelphia COM 76.6 11.0 4.6 0.0 92.2

8
ohio univ COM 76.0 13.5 2.1 0.0 91.6

9
univ of north texas COM 76.5 14.7 0.0 0.0 91.2

10
univ of osteopathic medicine & Health serv 79.6 8.8 2.7 0.0 91.1

11
new york COM 81.3 5.4 3.6 0.6 90.9

12
NOVA southeastern univ COM 74.2 13.3 3.3 0.0 90.8

13
lake erie COM 72.1 14.8 3.3 0.0 90.2

14
univ of health science COM 70.8 9.2 4.2 0.0 84.2

15
western univ COM 74.6 5.9 3.4 0.0 83.9

16
oklahoma state univ COM 60.9 10.1 7.2 0.0 78.2


Unranked

- Arizona COM - First class graduates in May 2000.

- Pikeville College SOM - First class graduates in May 2001.

- Touro Univ COM - First class graduates in May 2001.