Influences of Medical School Admissions Practices on Primary Care Career Choice

BACKGROUND AND OBJECTIVES: Medical schools should understand how to matriculate students who are more likely to enter primary care specialties and put admissions processes into place that achieve this result. However, there are no existing reviews that have systematically evaluated medical school admission practices and primary care specialty choice. METHODS: We conducted a narrative synthesis utilizing a systematic literature search to evaluate the effectiveness of medical school admission strategies designed to increase the percentage of graduates entering primary care specialties. RESULTS: We included 34 articles in the narrative review. Multiple prematricu-lation programs that appear to produce students with a high likelihood of entering primary care have been described in the literature. However, all of these studies are from single institutions, were observational, and limited by selection bias. Applicants who self-identify an interest in primary care, grew up with a rural background, and are older at matriculation are more likely to enter primary care, with stated interest in primary care being most predictive. Gender and race have been associated with primary care specialty choice in some studies, but not all. Insufficient literature on admissions policies and procedures exists to draw conclusions about best practices. CONCLUSIONS: Medical schools that want to increase the percentage of graduates entering primary care should consider developing a prematriculation program that attracts and prepares motivated and talented students with primary care interest. Admissions committees should understand which demographic criteria are associated with increased likelihood of entering primary care. The most important identifiable trait is an applicant’s stated interest in primary care.