Predictors of final specialty choice by internal medicine residents

BACKGROUND: Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention. OBJECTIVE: To identify factors that predict the clinical practice of residents following their training. DESIGN: Prospective cohort study. PARTICIPANTS: Two hundred and four categorical residents from 2 university-based residency programs. MEASUREMENTS: Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later. RESULTS: International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, P<.001). Residents with higher loan indebtedness more often became generalists (P=.001). A corresponding trend favoring general internal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%, P=.08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05<P<.10). In a logistic regression, graduation from a U.S. medical school (odds ratio [OR] 3.02; 95% confidence interval [CI], 1.00 to 9.10, P=.049) and perception of low future income (OR 1.65; 95% CI, 1.06 to 2.56, P=.03) predicted entry into general medicine, with trends apparent for higher debt (P=.05) and greater comfort caring for patients with psychological problems (P=.07). CONCLUSION: Recruitment of IMGs may not increase the supply of General Internists. Prospects of lower income, even in the face of large debt, may not discourage residents from becoming generalists. If increasing generalist manpower is a goal, residencies should consider weighing applicants' personal attributes during the selection process.