US Medical Student Plans to Practice in Underserved Areas

Dyrbye, Liselotte N.; Brushaber, Danielle E.; West, Colin P.

doi:10.1001/jama.2023.19521

“…The results confirm that racially and ethnically minoritized medical students have stronger intentions to practice in underserved areas, but the analysis then links these intentions with the much needed and continued diversification of the medical workforce. The authors imply that to meet the needs of underserved areas, more racially and ethnically minoritized medical students must be recruited into the medical pipeline.…”

mentioning

confidence: 61%

“…To the Editor The research letter by Dyrbye and colleagues explored US medical student plans to practice in underserved areas and further disaggregated how racially and ethnically minoritized medical students might address the physician workforce shortage in these areas.…”

mentioning

confidence: 99%

Medical Student Intent to Practice in Underserved Areas

Soh

2024

JAMA

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In Reply We appreciate the thoughtful letter by Dr Shi regarding our systematic review and meta-analysis 1 of pharmacotherapies for alcohol use disorder. Regarding the metaanalyses that included multiple doses, the analyses were stratified by dose whenever possible (eg, 50-mg oral naltrexone and 100-mg oral naltrexone). 1 More details are provided in the full evidence report. 2 In the case of injectable naltrexone, there were simply too few studies to stratify the analysis by dose. Given the findings from those studies, our conclusions would not change. The same is true for the acamprosate studies noted by Shi. Seven studies used a range of doses, presumably based on individual participants' ability to tolerate the medication. There was an insufficient number of studies for a valid dose comparison. For the 2 studies that had multiple groups using different doses, no dose showed superiority. Therefore, current evidence does not suggest a difference in outcomes by acamprosate dose.Regarding disulfiram, evidence from well-controlled studies does not support efficacy compared with placebo for improving alcohol consumption outcomes. 2 However, some trials did report a reduction in drinking days among those who returned to any drinking and who had a complete set of assessment interviews. It is therefore possible that disulfiram could be beneficial for some patients.There are challenges in designing trials to adequately evaluate a medication, such as disulfiram, with its unique deterrent mechanism. The available trials do not establish efficacy. However, the trials do suggest that combination programs of counseling, support, and coaching along with disulfiram may work for motivated patients who are interested in taking disulfiram and in adhering to the medication.In addition, the reported effects of pharmacotherapy for patients with alcohol use disorder result from a combination of medication and psychosocial interventions. 2 In other words, the benefits observed reflect the added benefit of medications beyond those of counseling and placebo, and there is uncertainty regarding the benefits of the medications when used alone without psychosocial co-interventions.

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“…In our study of 45 687 graduating medical students, those who identified as female; bisexual, gay, or lesbian; American Indian or Alaska Native; Black or African American; Hispanic, Latino, or of Spanish origin; and Native Hawaiian or Other Pacific Islander had higher odds of intent to practice in underserved areas than those who did not identify with any of these groups …”

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confidence: 74%

“…In Reply We appreciate the thoughtful comments from Mr Akimoto and colleagues and Dr Soh regarding our recently published study . We wish to clarify that we did not state nor did we intend to imply that any specific demographic of physicians is uniquely responsible for caring for patients in underserved areas.…”

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confidence: 96%

Medical Student Intent to Practice in Underserved Areas—Reply

Dyrbye,

West

2024

JAMA

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In Reply We appreciate the thoughtful letter by Dr Shi regarding our systematic review and meta-analysis 1 of pharmacotherapies for alcohol use disorder. Regarding the metaanalyses that included multiple doses, the analyses were stratified by dose whenever possible (eg, 50-mg oral naltrexone and 100-mg oral naltrexone). 1 More details are provided in the full evidence report. 2 In the case of injectable naltrexone, there were simply too few studies to stratify the analysis by dose. Given the findings from those studies, our conclusions would not change. The same is true for the acamprosate studies noted by Shi. Seven studies used a range of doses, presumably based on individual participants' ability to tolerate the medication. There was an insufficient number of studies for a valid dose comparison. For the 2 studies that had multiple groups using different doses, no dose showed superiority. Therefore, current evidence does not suggest a difference in outcomes by acamprosate dose.Regarding disulfiram, evidence from well-controlled studies does not support efficacy compared with placebo for improving alcohol consumption outcomes. 2 However, some trials did report a reduction in drinking days among those who returned to any drinking and who had a complete set of assessment interviews. It is therefore possible that disulfiram could be beneficial for some patients.There are challenges in designing trials to adequately evaluate a medication, such as disulfiram, with its unique deterrent mechanism. The available trials do not establish efficacy. However, the trials do suggest that combination programs of counseling, support, and coaching along with disulfiram may work for motivated patients who are interested in taking disulfiram and in adhering to the medication.In addition, the reported effects of pharmacotherapy for patients with alcohol use disorder result from a combination of medication and psychosocial interventions. 2 In other words, the benefits observed reflect the added benefit of medications beyond those of counseling and placebo, and there is uncertainty regarding the benefits of the medications when used alone without psychosocial co-interventions.

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“…To the Editor A recent research letter by Dyrbye and colleagues evaluated medical students’ intent to practice in underserved areas by race, ethnicity, sex, and sexual orientation between 2019 and 2021. Dyrbye and colleagues found that American Indian or Alaska Native; Black or African American; Hispanic, Latino, or of Spanish origin; and Native Hawaiian or Other Pacific Islander medical students were significantly more likely to report intent to practice in underserved areas. As Native Hawaiian or Other Pacific Islander physicians and researchers, we commend the authors on abiding by federal race standards, including Indigenous students, and offer further context to these findings …”

mentioning

confidence: 99%

Medical Student Intent to Practice in Underserved Areas

Akimoto,

Taitano-Ritter,

Taparra

2024

JAMA

0

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In Reply We appreciate the thoughtful letter by Dr Shi regarding our systematic review and meta-analysis 1 of pharmacotherapies for alcohol use disorder. Regarding the metaanalyses that included multiple doses, the analyses were stratified by dose whenever possible (eg, 50-mg oral naltrexone and 100-mg oral naltrexone). 1 More details are provided in the full evidence report. 2 In the case of injectable naltrexone, there were simply too few studies to stratify the analysis by dose. Given the findings from those studies, our conclusions would not change. The same is true for the acamprosate studies noted by Shi. Seven studies used a range of doses, presumably based on individual participants' ability to tolerate the medication. There was an insufficient number of studies for a valid dose comparison. For the 2 studies that had multiple groups using different doses, no dose showed superiority. Therefore, current evidence does not suggest a difference in outcomes by acamprosate dose.Regarding disulfiram, evidence from well-controlled studies does not support efficacy compared with placebo for improving alcohol consumption outcomes. 2 However, some trials did report a reduction in drinking days among those who returned to any drinking and who had a complete set of assessment interviews. It is therefore possible that disulfiram could be beneficial for some patients.There are challenges in designing trials to adequately evaluate a medication, such as disulfiram, with its unique deterrent mechanism. The available trials do not establish efficacy. However, the trials do suggest that combination programs of counseling, support, and coaching along with disulfiram may work for motivated patients who are interested in taking disulfiram and in adhering to the medication.In addition, the reported effects of pharmacotherapy for patients with alcohol use disorder result from a combination of medication and psychosocial interventions. 2 In other words, the benefits observed reflect the added benefit of medications beyond those of counseling and placebo, and there is uncertainty regarding the benefits of the medications when used alone without psychosocial co-interventions.

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US Medical Student Plans to Practice in Underserved Areas

Abstract: This study explores US medical students’ intent to practice in underserved areas, analyzed by demographic characteristics.

Cited by 8 publications

References 4 publications

Medical Student Intent to Practice in Underserved Areas

Medical Student Intent to Practice in Underserved Areas

Medical Student Intent to Practice in Underserved Areas—Reply

Medical Student Intent to Practice in Underserved Areas

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