A Need for Diversity: Factors Contributing to Graduating Medical Students’ Intention to Practice in Underserved Areas in Pediatrics

Background: In underserved communities, children and their families are more likely to experience lower health literacy, decreased access to specialty medical care, and inability to pay for medical services. Such factors are associated with worse health outcomes, and despite loan repayment incentive programs, a need for increased pediatric provider recruitment to underserved areas still exists. Diversity with the physician workforce has demonstrated better health outcomes and improved patient satisfaction, particularly among ethnically diverse and underserved patient populations. This study aims to describe the demographics and factors of students pursuing pediatrics with stated intention to work in underserved areas

Methods: De-identified data was obtained from the AAMC Graduation Questionnaire and analyzed. This survey was given to 42,835 graduating US MD students matriculating between 2007 and 2012.

Results: 10.95% of all survey respondents reported intent to pursue pediatrics. Students pursuing pediatrics were more likely to report intention to work in an underserved area compared to their non-pediatric counterparts. Overall, students who identify as non-Hispanic Black/African-American, Hispanic, or Multiracial, received a scholarship in medical school, pursued dual degrees, had experiences in providing health education in the community, experiences related to health disparities, and experiences in global health were more likely to intend to practice in an underserved area. In terms of ethno-racial diversity, Hispanic students were twice as likely to report intention and non-Hispanic Black/African-American students were more than four times as likely to report intention. Conversely, male students, students matriculating at 23 years of age or older, and MD-PhD degree-holding students, and those requiring the use of an interpreter when needed were less likely to report intention to practice in an underserved area.

Conclusion: This study is the first to our knowledge to examine what demographics and experiences associated with students pursuing pediatrics intention to practice in underserved areas. Our findings highlight that Black, Hispanic, and Multiracial students have a higher likelihood of intention to practice in underserved areas while males and older medical school matriculates were less likely. Experiences of students were also significant, as providing health education in the community, experiences related to health disparities, and experiences in global health were associated with increased intention to practice in underserved areas as well. These results provide a potential target for interventions at the medical school level to increase the underserved pediatric workforce.