1. Factors Influencing Medical Students to Enter A Family Medicine Residency at Their Own Institution
Richard Pretorius, MD, MPH
Karen Devlin
SUNY AT BUFFALO
STFM 34th Annual Predoctoral Education Conference
Portland, Oregon January 26, 2008

2. PROBLEM: 10-year decline by 53% in US seniors entering family medicine
53% from 2340 to 1107 (1997 to 2007)

3. BACKGROUND Recruitment faces new challenges.
Fam med residents who train at the same institution where they attended medical school are familiar the strengths & weaknesses of both programs.
RESEARCH QUESTION: What factors influence medical students to enter a family medicine residency at their own institution?

4. METHOD Structured interviews 19 open ended questions
N=8 fam med residents
Med school & residency
were identical: SUNY
at Buffalo

5. METHOD Residency program
32 full time physician faculty
3 sites in Buffalo
urban county hospital (ECMC) + urban clinic 5 residents/year
urban not-for-profit hospital (BGH) + 2 urban clinics 6 residents/year
suburban not-for-profit hospital (MFG) + suburban clinic 4 residents/year
8/42 (19%) family medicine residents at SUNY at Buffalo also graduated from medical school at SUNY at Buffalo.
All 8 residents were interviewed
100% response rate

6. RESULTS
Location of high school and college of 8 residents in study group:
high school
college
local 4
New York State 2 1
out-of-state 3

7. RESULTS The medical school (SUNY at Buffalo) was chosen because of:
location (4)
acceptance (4)
reputation (2)
scholarship (1)
focus on primary care (1)
inexpensive (1)

8. RESULTS The residency (SUNY at Buffalo) was chosen because of:
program (6)
holistic medicine
extracurricular and research opportunities
integrated clinical experience
good reputation
familiar medical system
continuity of school
faculty (6)
location (5)
Program: familiar medical system, holistic medicine, continuity, extracurricular, research, integrated clinical experience, good training

9. RESULTS Advantages of UB medical school:
curriculum (5)
student groups (2)
research (2)
hospitals (1)
patient diversity (1)
reputation (1)
state university (1)
faculty (1)
cost (1)
Disadvantages of UB medical school
none (2)
curriculum (2)
no academic hospital (2)
not prepared for boards (1)
limited study time (1)
too many lectures (1)
Curriculum—SP, new curriculum, integrated clin exp, strong curriculum

10. RESULTS Disadvantages of UB fam med residency
specific rotations (4)
competition with other residents to see pts (3)
quality of residents (2)
fam med bashing (2)
dispersed campus (1)
large size (1)
none (1)
Advantages of UB fam med residency
faculty (6)
program (4)
research (3)
diverse learning opportunities (3)
patients (2)
hospitals (2)
residents (1)
established pgm (1)
location (1)
academic pgm (1)
supports resident's family (1)

11. RESULTS When decision was made to specialize in family medicine?
In medical school (4):
Begun in 2nd yr med school, solidified after fam med clerkship
End of 3rd year
Prior to med school, finalized in 3rd year
4th year
Before medical school (3):
“Always what I wanted to do”
Confirmed with Peace Corp experience
Note: one resident did not provide answer.

12. RESULTS Other specialties seriously considered:
psychiatry (seriously), peds & med/peds (not seriously)
psychiatry, fam med/psych, med/psych
ER, ortho
psychiatry
surgery, ER, IM (gastroenterology)
peds
none

13. RESULTS
Factors that most influenced the resident’s decision to go into family medicine:
faculty (2)
residents (2)
prevention (2)
familiarity (1)
liked every clerkship (1)
continuity of care (1)
challenge (1)
primary care (1)
patients (1)
underserved populations (1)
clerkship (1)
lifestyle (1)

14. RESULTS
Important factors for helping medical students decide to enter family medicine:
exposure to family physicians (3)
clerkship (3)
explain what family physicians do (2)
ability to earn a good income (1)
international rotations (1)
mentors (1)
procedures (1)
opportunity to do pediatrics and obstetrics (1)
emphasizing positives (1)

15. DISCUSSION
A variety of factors influenced a resident’s decision to enter family medicine (12) as well for the resident’s medical school classmates (9).
Exposure to positive role models, good clerkship experiences and explanations as to family medicine’s unique characteristics were among the most popular reasons cited.
Medical students decide to enter family medicine for a variety of personal reasons.
A multimodality approach to recruitment will likely give the best results.
Family medicine is a broad specialty.