PM2094: The Influence of Family on Choosing Pediatric Fellowship Training and Subspecialty Careers

Background: Pediatrics, along with the medical profession at large, has become increasingly invested in understanding factors that contribute to a diverse physician workforce. The impact of having familial, intergenerational ties to medicine on a learner’s choice to pursue fellowship training and a subspecialty career in pediatrics is underexplored. We sought to examine whether having older family members in medicine is associated with choosing a primary-care vs subspecialty career in pediatrics.

Methods: A cross-sectional online survey was distributed to US medical students and physicians from 6/11/2021-12/11/2021 through medical school and faculty listservs, student interest groups, and professional identity- and specialty-based organizations. Having family in medicine was defined as having a parent, grandparent, or aunt/uncle in medicine. Responses were analyzed using chi-square test for categorical variables and t-test or ANOVA for continuous variables. Logistic regression was used to identify factors associated with entering primary-care vs subspecialty (e.g., gastroenterology) pediatric careers.

Results: Data from 765 pediatricians and individuals intending to practice pediatrics (414 [54.1%] attendings and residents/fellows, 338 [44.2%] students, 12 [1.6%] non-active physicians) were sourced. The analytic dataset was comprised of individuals identifying as Asian (107 [14.0%]), non-Hispanic Black [NHB] (37 [4.8%]), Hispanic (56 [7.3%]), non-Hispanic White [NHW] (518 [67.7%]), non-Hispanic Other [NHO] (19 [2.5%]), and non-Hispanic multiple races (28 [3.7%]). Underrepresented in medicine (URiM) was defined as NHB, NHO, or Hispanic. The dataset included 535 [69.9%] cis-gender women and 601 [78.6%] respondents in a pediatric subspecialty. There was no difference with regards to having family in medicine between women and men (33.6% vs 37.6%; p=0.59) or between URiM and non-URiM individuals (32.1% vs 35.1%; p=0.55). Women were less likely than men to pursue a pediatric subspecialty (76.1% vs 84.5%; p=0.03). There was no significant difference in proportion of primary-care vs pediatric subspecialty careers by race/ethnicity (p=0.32). Individuals who began or completed part of their graduate medical education outside of the US were more likely to pursue a pediatric subspecialty (100% vs 83.2%, p=0.009). Logistic regression revealed that having one parent in medicine was positively associated with pursuing a pediatric subspecialty compared to having no parents (OR=2.02 [95% CI 1.08-3.77]; p=0.03), but having two or more parental figures in medicine was not (p=0.38).

Conclusion: Having one parent in medicine was positively associated with pursuing a pediatric subspecialty. While men and women had similar rates of familial ties to medicine, men were still more likely to pursue fellowship training and a subspecialty career. No statistically significant differences were seen between URiM and non-URiM individuals regarding intergenerational familial ties to medicine or subspecialty career choice. Further studies are warranted to understand how having a parental figure in medicine may influence diversity and career differentiation within the field of pediatrics.