Women almost twice as likely to choose primary care as men

Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association. Researchers sought to understand the factors that are associated with an increased likelihood of specializing in primary care.

"Considering the critical need for primary care physicians in the United States, there's great value in understanding our primary care pipeline," says Caleb Scheckel, DO, an oncology specialist at the Mayo Clinic Hospital Rochester and co-author of the study. "Based on our findings, it's fair to say that osteopathic medical schools that invest in female candidates, invest in primary care."

Ensuring routine access to primary care is a critical way to improve health outcomes and reduce costs. According to the research, even one additional primary physician per 10,000 people in a population decreases emergency department visits, hospitalizations and elective operations.

Mapping the path to primary care

"The shortage of primary physicians and the shifting physician workforce make identifying influences on specialty choice mission-critical," says Katherine Stefani, a third-year medical student at Midwestern University Arizona College of Osteopathic Medicine and lead author of the study. "The data reveals that perceived lifestyle—more than debt, prestige or ability—has the strongest impact on specialty choice among osteopathic medical school students."

Researchers analyzed self-reported data from annual American Association of Colleges of Osteopathic Medicine graduate surveys spanning a ten-year period. They looked at the following factors influencing specialty choice:

• Intellectual and technical content;
• Debt level;
• Lifestyle;
• Prestige/income level; and
• Personal experience and abilities.

Regardless of specialty choice, the students surveyed said lifestyle was the most important factor when it came to picking a specialty. Students entering primary care were more likely to report prestige and income level to be of "no or minor influence" compared with students entering non-primary care specialties.

Debt level was more likely to be a "major influence" to students choosing to enter non-primary care specialties than to those entering primary care. A 2019 study demonstrated that the use of loan forgiveness programs mitigated the effect of debt on specialty selection.

"There's no simple solution to fixing the primary care shortage," says Dr. Scheckel. "But what is clear is the growth in the number of osteopathic primary care physicians is being driven by female students."

Osteopathic medical schools are responsible for training a large portion of primary care physicians, with an estimated 56% of current osteopathic physicians practicing in a primary care field. The proportion of women actively practicing osteopathic medicine has also increased, from 18% in 1993 to 42% today.