Institutional Characteristics Influencing Medical Student Selection of Primary Care Careers: A Narrative Review and Synthesis

BACKGROUND AND OBJECTIVES: There is an ongoing shortage of primary care physicians in the United States. Medical schools are under pressure to ad-dress this threat to the nation's health by producing more primary care grad-uates, including family physicians. Our objective was to identify institutional characteristics associated with more medical students choosing primary care. METHODS: We conducted a systematic literature review with narrative synthe-sis to identify medical school characteristics associated with increased numbers or proportions of primary care graduates. We included peer-reviewed, published research from the United States, Canada, Australia, and New Zealand. The exist-ing literature on characteristics, including institutional geography, funding and governance, mission, and research emphasis, was analyzed and synthesized into summary statements. RESULTS: Ensuring a strong standing of the specialty of family medicine and creating an atmosphere of acceptance of the pursuit of primary care as a ca-reer are likely to increase an institution's percentage of medical students en-tering primary care. Training on regional campuses or providing primary care experiences in rural settings also correlates with a larger percentage of gradu-ates entering primary care. A research-intensive culture is inversely correlated with primary care physician production among private, but not public, institu-tions. The literature on institutional financial incentives is not of high enough quality to make a firm statement about influence on specialty choice. CONCLUSIONS: To produce more primary care providers, medical schools must create an environment where primary care is supported as a career choice. Medical schools should also consider educational models that incorpo-rate regional campuses or rural educational settings.