Early Immersion and Primary Care Careers: Evidence From a Preclerkship Rotation

Purpose

The United States is facing a primary care workforce crisis that is impacting the overall health of the population. The University of Washington School of Medicine’s Rural Underserved Opportunities Program (RUOP) is a 4-week primary care preclerkship rotation. This study examined whether early and immersive exposure to primary care is independently associated with a career choice in primary care overall and family medicine as a distinct specialty.

This retrospective cohort study included 2,234 students who matriculated at the University of Washington School of Medicine between 2003 and 2015. Program records were linked to American Medical College Application Service data, a matriculation career-preference survey, and the American Medical Association Physician Masterfile. The outcomes were practice in primary care (family medicine, internal medicine, and pediatrics) and family medicine; the exposure was RUOP participation. Covariates included age; sex; parental educational level; rural upbringing; Washington, Wyoming, Alaska, Montana, or Idaho origin; and 17 baseline specialty or practice setting interests. Multivariable logistic regression generated adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Of the 2,234 graduates, 1,104 (49.4%) completed RUOP. Among RUOP participants, 533 (48.2%) were practicing primary care compared with 328 of the 1,130 non-RUOP graduates (29.3%). In multivariate regression, RUOP participation was associated with higher odds of practicing primary care (OR, 1.39; 95% CI, 1.10-1.76; P = .01) and family medicine practice (OR, 1.54; 95% CI, 1.11–2.14; P =  .01).

RUOP was associated with higher odds of practicing both primary care and family medicine. Although confounding factors cannot be entirely excluded, these findings suggest that short, preclerkship primary care immersions may support students’ trajectories toward primary care careers. Medical schools aiming to strengthen the primary care pathway should consider incorporating similar experiences into their curricula.