A “U-shaped" Curve: Appreciating How Primary Care Residency Intention Relates to the Cost of Board Preparation and Examination

Abstract

Introduction: The shortage of primary care physicians in the United States has warranted an investigation into how medical education debt and other factors influence medical students’ interests in primary care (PC) residencies. However, sparse research has studied how the cost of board preparation and examination relates to career choice. The objective of this study was to determine if there is an association between the cost of preparing and sitting for board examinations and the intention to enter a PC residency for osteopathic medical students.Methods: We postulated that students who incurred higher financial costs from preparing and sitting for board examinations would be more likely to be interested in non-primary care (NPC) residencies. Using a non-experimental survey design, this study asked respondents to evaluate the following: “I plan to enter a Primary Care Residency (Family Medicine OR General Internal Medicine OR Pediatrics)” using a Likert scale. Respondents were also asked to select which board examination(s) and pertinent resource(s) they had purchased. Total costs were calculated per student.Results: A total of 25,852 osteopathic medical students received the survey, of which 1,280 students responded to and completed it, yielding a 4.95% response rate. The distribution of respondents’ intentions to pursue a primary care residency and costs spent yielded a “U” shaped curve. Respondents who Strongly Agreed and Strongly Disagreed to the statement “I plan to enter a Primary Care Residency” spent $5,744 and $5,070 on board-preparation and examination, respectively. No statistically significant differences were found between the cost of preparing and sitting for board examinations and the intention to enter primary care residencies when individuals were grouped by year in school and gender.Conclusions: Because competitive NPC specialties have relatively higher salaries, we suspected that students who intended to pursue these specialties would have had higher financial costs from board examination and preparation compared to students who intended to pursue PC residencies such as family medicine. Our findings further illustrate these specific educational costs do not correlate with students’ stated intentions to enter primary care residencies. As efforts continue to determine a solution for the primary care physician shortage, it becomes clearer that the focus must also encompass non-financial influences that shape career choice.

A Comparison of Selected Items Found in Graduation Survey Instruments from MD and DO Schools. What It Reveals About Satisfaction with Career Choice

“…A rising student debt and higher expectations on board exam performance for specialty choice [9][10][11] could be to blame as well. The cost of preparation and examination increases during the clerkships [23,24], and rising debt has been negatively associated with mental well-being and academic outcomes [25]. For both DO and MD students matching into a desired first-choice GME specialty, it has become overwhelmingly dependent specifically on performance in board exams [26,27].…”

Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective

“…For medical students, deciding on a residency specialty that will guide careers and impact personal lives is a complicated and multifactorial process, made even more difficult by the complex and stressful nature of attempting to switch residency specialties post hoc [ 1 ]. These decisions have broad implications regarding healthcare and biomedical research across the globe, namely an imbalance between physician supply and demand in primary care [ 2 – 4 ], surgery [ 5 – 7 ], research [ 8 – 10 ], and clinical subspecialties [ 11 – 13 ], a disparity that dates back over a century and will continue to worsen for the foreseeable future [ 14 – 16 ]. These disparities can have a significant impact on healthcare outcomes.…”

Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective

“…For medical students, deciding on a residency specialty that will guide careers and impact personal lives is a complicated and multifactorial process, made even more difficult by the complex and stressful nature of attempting to switch residency specialties post hoc (1). These decisions have broad implications regarding healthcare and biomedical research across the globe, namely an imbalance between physician supply and demand in primary care (2)(3)(4), surgery (5)(6)(7), research (8)(9)(10), and clinical subspecialties (11)(12)(13), a disparity that dates back over a century and will continue to worsen for the foreseeable future (14)(15)(16). These disparities can have a significant impact on healthcare outcomes.…”