Professional affinity and medical student interest in family and community medicine: determinants of specialty choice

Brazilian primary care faces a persistent recruitment problem. Despite the Family Health Strategy serving as the organizational backbone of the Sistema Único de Saúde (SUS), fewer than one in ten new graduates in many high-income countries enter family medicine. This narrative review examines the reasons why students choose or do not choose family and community medicine (FCM) and what changes in Brazilian medical education would be needed to convert latent interest into a stable career commitment. Drawing on international evidence and Brazilian studies, the review traces the lifestyle, continuity, and social-accountability motivations that pull students toward FCM; the institutional pressures, prestige hierarchies, and financial signals that push them away; and the educational designs (longitudinal integrated clerkships, family medicine interest groups, community-based curricula aligned with the Family Health Strategy) that show the most consistent association with sustained recruitment. Professional affinity is treated as a mediator of the choice, not as the central explanation. The review provides suggestions of policy implications for medical schools, residency planners, and SUS workforce policy.