Addressing national health care needs: recent US MD graduates and their intention to practice in underserved areas

Purpose This study assesses independent variables associated with recent US MD-granting medical school graduates’ intention, at graduation, to practice in underserved areas (underserved practice intention [UPI]). Method This retrospective cohort study used national deidentified graduate-respondent data from the Association of American Medical Colleges’ Graduation Questionnaire (among other sources) from 2018-2019 through 2021-2022 to perform bivariate analysis and multilevel (graduates nested by school) logistic regression, examining independent associations between demographic characteristics, early-career intentions, medical school exposures and setting, and postgraduation professional plans and whether respondents had UPI at graduation. Results Among 56,484 respondents from 142 schools, 15,889 (28%) reported UPI (median, 26%; range, 11%-69%; P < .001). In multilevel logistic regression, UPI likelihood was higher among graduates from low vs high socioeconomic backgrounds (adjusted odds ratio [AOR], 1.21; 95% CI, 1.15-1.28), from rural vs nonrural backgrounds (AOR, 1.60; 95% CI, 1.47-1.75), with vs without UPI at matriculation (AOR, 7.87; 95% CI, 7.07-8.76), who reported participation in 2 or more vs 0 preparatory electives for working with underserved communities (2 electives: AOR, 1.26; 95% CI, 1.11-1.42; 6 electives: AOR, 3.02; 95% CI, 2.63-3.48), and planning general primary care (AOR, 3.40; 95% CI, 3.15-3.67) or emergency medicine (AOR, 2.25; 95% CI, 2.07-2.44) specialties, each vs internal medicine with a subspecialty. UPI likelihood was lower among graduates planning non-general surgical (AOR, 0.54; 95% CI, 0.49-0.60) and all other (nonsurgical) specialties (AOR, 0.58; 95% CI, 0.54-0.63). Conclusions This study identified demographic characteristics, early-career intentions, medical school exposures, and postgraduation professional plans associated with increased odds of UPI at graduation. These findings highlight multiple points in the medical education continuum where UPI might be fostered or sustained among students with varied backgrounds, exposures, and career plans, supporting medical school efforts that contribute to physician workforce needs in underserved areas. Teaser Text Among 4 recent national cohorts of US MD-granting medical school graduates (71% of all graduates from 2019-2022), this study identified demographic characteristics, early-career intentions, medical school exposures, and postgraduation professional plans that were independently associated with increased odds of intention, at graduation, to practice in underserved areas, using a model accounting for medical school given the wide-ranging proportion of graduates with this career intention across schools. The study findings highlight multiple points in the medical education continuum where intention to practice in underserved areas can be fostered or sustained among students with various experiences, exposures, and career plans, supporting medical school efforts that can contribute to physician workforce needs in underserved areas.