The number of medical students entering primary care residencies continues to decrease. The association between student attitudes toward underserved populations and residency choice has received little attention even though primary care physicians see a larger proportion of underserved patients than most other specialists. We evaluated attitudes toward underserved populations in 826 medical students using a standardized survey, and used logistic regression to assess the effect of attitudes, along with other variables, on selection of a primary care residency. We compared results between two groups defined by year of entry to medical school (1993-99 and 2000-05) to determine whether associations differed by time period. Students' attitudes regarding professional responsibility toward underserved populations remained high over the study period; however, there was a statistically. significant association between positive attitudes and primary care residency in the early cohort only. This association was not found in the more recent group.
"Comparing those who entered medical school between 1993–1999 and 2000–2005, Wayne and colleagues (2010) find a significant association between positive attitudes about professional responsibility toward the underserved and primary care specialty choice in the early cohort. "
[Show abstract][Hide abstract] ABSTRACT: This study assesses whether racialized patterns of medical specialization persist among a recent cohort of U.S. medical students. Data from the Association of American Medical College's 2004 Graduation Questionnaire (GQ), an annual survey of all graduating U.S. medical students, are employed to explore how factors internal and external to medical education influence specialization patterns among black and white medical school graduates. The data suggest that a degree of racial division in medical specialization endures, but that division does not neatly map onto specialty prestige and is deeply gendered. Black graduates are more likely to enter high-prestige surgical residency programs than their white colleagues, but this finding holds only for male medical school graduates. That the surgery effect emerges only with the inclusion of social factors inside and outside medicine suggests these have distinct impact across race. We conclude by suggesting directions for future studies of stratification in medicine.
" Wayne (2010) demonstrated that while positive attitudes toward the underserved correlated with primary care specialty choice in the past, a strong relationship no longer widely exists.  This research indicates that students entering medical school continue to feel that physicians have a responsibility toward individuals with limited access to health care. It also raises questions about the impact of medical education and training on student attitudes – why do these attitudes change and how can student altruism be preserved and supported? "
[Show abstract][Hide abstract] ABSTRACT: The attitudes of medical students toward the current United States healthcare system are not well described in the literature. A graded survey was developed to assess awareness and motivation toward the care of the uninsured and underinsured as well as the impact of a video intervention on these attitudes. The survey, which showed good internal consistency (Cronbach's alpha = 0.85), was administered before and after viewing a collection of videotaped patient stories. Although a spectrum of beliefs emerged from the analysis of survey responses, some common attitudes were identified. Eighty-five percent of respondents either agreed or strongly agreed that medical care should be provided to everyone, regardless of their ability to pay. In addition, 66% indicated they would be willing to forgo a portion of their income to provide care to those who do not have access to healthcare services. These values were strongly correlated with increasing respondent age and primary care specialty choice (p<0.01). The video intervention did not heavily influence student responses, perhaps due to a ceiling effect created by the large number of students who were already sympathetic toward the underserved. Overall, this data reflects that United States medical students recognize a need to provide care to the underserved and are willing to make personal sacrifices to meet that need.
PLoS ONE 12/2012; 7(12):e51827. DOI:10.1371/journal.pone.0051827 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Patient Protection and Affordable Care Act (PPACA) signed by President Obama on March 23, 2010, is a far-reaching law
intended to improve access to and the quality of health care for Americans. Recognizing the importance of the health workforce
to the nation’s health, the Act addresses health workforce and health professions education and training issues through provisions
to strengthen the primary care workforce, provide tax relief for health professionals with state loan repayments, establish
a national Health Care Workforce Commission, and expand the primary healthcare workforce by increasing and improving low-interest
student loans. It is estimated that PPACA would afford access to health care for 32 million more currently uninsured new healthcare
consumers, many of which ethnic and racial minorities or members of other vulnerable groups. As the Act is enacted, the nation
is experiencing unprecedented demographic change. When the 2010 Census counts are tallied, we may finally grasp the degree
of demographic shifts that the nation has undergone in the past decade. Since the 2000 Census, data gleaned from the American
Community Survey and demographic models such as the one carried out by the Pew Research Center (Passel and Cohn, U.S. population
projections: 2005–2050. Washington, DC: Pew Research Center: Social and Demographic Trends, 2008) predict major population
shifts. By 2042, one in two Americans will be an Asian American, Pacific Islander, African American, Hispanic, American Indian,
and/or Alaska Native. Since 2000, Hispanics have accounted for over one-half of the population increase in the United States.
The number of Asian Americans grew at a larger proportion (9.0%) than any other racial or ethnic group during this same time
period. In at least four states (California, Hawaii, Texas, and New Mexico) and the District of Columbia, racial and ethnic
“minorities” constitute a majority of the population (U.S. Census Bureau, An older and more diverse nation by midcentury,
2008. http://www.census.gov/Press-Release/www/releases/archives/population/012496.html, Accessed 22 Oct 2008; U.S. Bureau
of Census, Hispanic Americans by the number, 2008. http://www.infoplease.com/spot/hhmcensus1.html, Accessed 9 Jan 2010). Moreover,
because of reproductive and immigration patterns, minorities are disproportionally represented among the younger population.
Today, minorities account for 43% of Americans under 20 years of age, and it is projected that over the next two decades minority
students will account for almost 40% of the total college population (Roberts, Minorities often a majority of the population
under 20, The New York Times, 2008). Despite the rapid growth of racial and ethnic minority groups in the United States, many
are dramatically underrepresented among the nation’s health professionals. The percentage of African American, Hispanic, American
Indian, Alaska Native, or Pacific Islander1 in the health professions has grown only modestly at best over the past 30 years. Yet relative to the growth of the minority
population in the United States, this rate of increase still leaves the proportion of minority health professionals outstripped
by several fold. Hispanics, for example, comprise over 15% of the U.S. population, but only 2% of the registered nurse population,
4.6% of psychologists, and 5.0% of physicians. Similarly, one in eight individuals in the United States is African American,
yet less than 1 in 20 dentists or physicians are African American. Minorities are severely underrepresented in academia. During
the 2007–2008 academic year, URMs (underrepresented minorities) made up only 7.4% of U.S. medical school faculty, fewer than
7% of undergraduate faculty, less than 10% of baccalaureate and graduate nursing school faculty, 12% of clinical psychology
faculty, and 8.6% of dental school faculty (Moreno et al., Using multiple lenses: an examination of the economic and racial/ethnic
diversity of college students. In: Univ AoACa, editor. California: The James Irvine Foundation, Claremont Graduate University,
2006; Institute of Medicine, In the nation’s compelling interest: ensuring diversity in the health-care workforce. Washington,
DC: Institute of Medicine, 2004; Hall, Clin Psychol Sci Pract 13:258–261, 2006).
KeywordsRacial and ethnic diversity-Ethnic and racial concordance-Communication-Racial stereotypes-Underrepresented minorities-“Distributive justice”-Health workforce shortage-Educational pipeline-Health professions educational institutions (HPEIs).
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