Medical Students’ Views of Medicine as a Calling and Selection of a Primary Care-Related Residency

DISCUSSION

Driven by an aging population and insurance coverage expansion, the US health care system is confronting a major shortage of primary care physicians.¹ Although efforts to increase the number of these physicians have focused on increasing the number of primary care residency positions and addressing the income gap between primary care and procedure-intensive specialties,^5,6 our study points to a professional identity factor that merits some consideration—fostering or at least not undermining a sense of calling among future physicians. From a medical education perspective, professional identity is “a representation of self, achieved in stages over time during which the characteristics, values, and norms of the medical profession are internalized, resulting in an individual thinking, acting, and feeling like a physician.”⁷ As such, professional identity formation that supports a career choice in primary care may require a learning environment where medical students are exposed to and interact with physicians who exemplify professionalism and a calling to the practice of medicine.⁸

Medical school culture may contribute to shaping students’ specialty preferences. Students who attend medical schools where primary care is less respected (such as potentially those with low social mission scores) are less likely to pursue a career in primary care.⁹ On the other hand, the likelihood of choosing a primary care specialty increases when medical students have positive experiences in primary care clerkships⁹ and greater exposure to generalist role models.¹⁰ Because preclinical medical students who are interested in primary care have been found to identify more with medicine as a calling,¹¹ exposing students to generalist role models as early as possible may be particularly important in translating specialty preference to career choice.

Another consideration to fostering a medical school culture that sustains students’ sense of calling may be to address the undue stressors and demands that their teachers—resident and attending physicians—face in the health care workplace. Higher physician burnout has been found to be associated with a lower sense of calling.¹² With increased prevalence in physician burnout and its negative consequences on quality of patient care, individual- and organizational-level strategies designed to reduce burnout are garnering greater attention and urgency.¹³ If these strategies are successful in reducing burnout, they may have the unintended benefit of ameliorating the primary care physician workforce shortage.

A key limitation of our study was that we assessed medical students’ entry into a primary care-related residency, not whether respondents will practice primary care after residency. Although proportions of resident physicians likely to pursue a career in primary care have been found to vary across primary care GME specialties (eg, family medicine: 0.91; internal medicine: 0.10–0.20; pediatrics: 0.44),¹⁴ studies that observe medical students after residency training are necessary to determine whether those who eventually practice primary care are more likely to have seen medicine as a calling.

With a projected primary care physician shortage, efforts aimed at sustaining future physicians’ sense of calling may help to address these workforce needs.