Background
Methods
Data analysis
Primary care
Rural (periphery) workforce
Incentives
Results
Primary care
Primary care | Undecided | No primary care | Primary care vs no primary care | Primary care | Females vs males | |||
---|---|---|---|---|---|---|---|---|
Females | Males | |||||||
N | 98 | 184 | 229 | 41 | 57 | |||
Female | 42% | 51% | 49% | |||||
Male | 58% | 50% | 51% | NS | ||||
Age (years) | 18–20 | 0% | 0% | 0.4% | 0% | 0% | ||
21–23 | 25% | 14% | 17% | 27% | 23% | |||
24–26 | 19% | 31% | 29% | 34% | 9% | |||
27–29 | 37% | 42% | 39% | 27% | 44% | |||
30–32 | 14% | 10% | 12% | 10% | 18% | |||
+ 32 | 5% | 4% | 3% | NS | 2% | 7% | p < 0.01 | |
Marital status | Single | 70% | 63% | 73% | 66% | 72% | ||
Married | 30% | 36% | 26. % | 34% | 26% | |||
Divorced | 1% | 1% | 0.4% | NS | 0% | 2% | NS | |
Thought of a specialty when started | Yes | 85% | 79% | 82% | 85% | 84% | ||
No | 15% | 21% | 18% | NS | 15% | 16% | NS | |
When did you start thinking of a specialty? | Pre - med school | 25% | 29% | 26% | 27% | 23% | ||
Year 1 | 4% | 4% | 4% | 6% | 2% | |||
Year 2 | 4% | 4% | 2% | 3% | 4% | |||
Year 3 | 4% | 3% | 5% | 0% | 6% | |||
Year 4 | 56% | 42% | 48% | 62% | 51% | |||
Year 5 | 9% | 19% | 16% | NS | 3% | 13% | NS | |
Have you changed your mind? | Yes | 61% | 59% | 63% | 59% | 62% | ||
No | 40% | 41% | 38% | NS | 41% | 38% | NS | |
When did you change your mind? | Year 1 | 0% | 0% | 2% | 0% | 0% | ||
Year 2 | 0% | 3% | 1% | 0% | 0% | |||
Year 3 | 2% | 1% | 2% | 0% | 4% | |||
Year 4 | 41% | 44% | 42% | 35% | 46% | |||
Year 5 | 57% | 52% | 54% | NS | 65% | 50% | NS | |
Specialties under consideration | Family medicine | 16% | 2% | 0% | 14% | 17% | ||
Pediatrics | 41% | 42% | 24% | 54% | 30% | |||
Internal med | 26% | 30% | 32% | 26% | 26% | |||
Ob/Gyn | 19% | 20% | 22% | 34% | 7% | |||
Emergency med | 4% | 0% | 2% | 0% | 7% | |||
Surgical* | 20% | 31% | 31% | 9% | 30% | |||
Other | 22% | 44% | 39% | p < 0.01 | 20% | 30% | p < 0.01 | |
High school location | Israel | 97% | 97% | 96% | 95% | 98% | ||
Other | 3% | 3% | 4% | NS | 5% | 2% | NS | |
High school location in israel | Jerusalem | 32% | 25% | 23% | 26% | 36% | ||
Central | 29% | 37% | 44% | 31% | 29% | |||
North | 26% | 28% | 23% | 33% | 21% | |||
South | 13% | 9% | 10% | 10% | 14% | |||
Other | 0% | 1% | 1% | NS | 0% | 0% | NS | |
Future residency location | Israel | 98% | 98% | 99% | 97% | 98% | ||
Other | 2% | 2% | 1% | NS | 3% | 2% | NS | |
Perferred residency location in Israel | Jerusalem | 28% | 18% | 23% | 23% | 31% | ||
Central | 22% | 32% | 34% | 13% | 29% | |||
North | 17% | 11% | 9% | 23% | 12% | |||
South | 1% | 1% | 2% | 3% | 0% | |||
Don’t know | 33% | 39% | 32% | p < 0.05 | 39% | 29% | p < 0.01 |
Primary care | Undecided | No primary care | Primary care vs no primary | Primary care | Females vs males | ||
---|---|---|---|---|---|---|---|
Females | Males | ||||||
N | 98 | 184 | 229 | 41 | 57 | 98 | |
Criteria for choosing a specialty | |||||||
Time with family (1) |
76%
| 73% | 65% | p < 0.03 |
85%
| 68% | p < 0.05 |
Specialty with team work |
57%
| 54% | 45% | p < 0.04 | 56% | 58% | NS |
Influence of spouse |
43%
| 43% | 31% | p < 0.007 |
49%
| 39% | p < 0.05 |
Specialty that deals with social issues (3) |
42%
| 35% | 22% | p < 0.001 |
51%
| 35% | p < 0.009 |
Daytime work only (1) |
26%
| 29% | 16% | p < 0.03 |
34%
| 19% | p < 0.03 |
Work only in the community |
9%
| 3% | 4% | p < 0.001 | 12% | 7% | NS |
Procedures/surgery | 43% | 41% |
57%
| p < 0.01 | 34% |
49%
| p < 0.02 |
High salary | 36% | 48% |
51%
| p < 0.002 | 34% | 38% | NS |
Opportunity for research (2) | 34% | 37% |
44%
| p < 0.05 | 27% | 39% | NS |
Academic faculty member | 19% | 26% |
30%
| p < 0.05 | 24% | 16% | NS |
Criteria for choosing a residency | |||||||
Much supervision by senior physicians |
53%
| 45% | 37% | p < 0.001 |
68%
| 42% | p < 0.04 |
Limited work hours |
29%
| 30% | 17% | p < 0.001 | 33% | 27% | NS |
Short residency (<4.5. years) |
28%
| 15% | 12% | p < 0.001 | 29% | 26% | NS |
Much clinic time (2) |
23%
| 16% | 5% | p < 0.001 | 20% | 25% | NS |
Hospital in the periphery (3) |
19%
| 7% | 6% | p < 0.001 | 20% | 19% | NS |
Leading department (1)a | 67% | 77% |
79%
| p < 0.03 | 71% | 65% | NS |
Large hospitial | 52% | 55% |
62%
| p < 0.04 | 59% | 47% | NS |
Family living location | 78% | 75% | 64% | NS |
88%
| 70% | p < 0.05 |
Making clinical decisions on your own | 66% | 50% | 55% | NS | 56% |
74%
| p < 0.05 |
Pre-determined work hours (2) | 47% | 48% | 35% | NS |
59%
| 39% | p < 0.05 |
Influence of family | 42% | 37% | 31% | NS |
54%
| 33% | p < 0.01 |
Many on-call shifts | 10% | 11% | 12% | NS | 5% |
14%
| p < 0.03 |
Demographics/criteria | Multivariable Backward regression coefficient | Backward logistic regression | |||
---|---|---|---|---|---|
p
| Odds ratio | 95% confidence limits |
P
| ||
Interest in a primary care residency | r = 0.43 | ||||
Male gender | 0.264 | 0.015 | 2.251 | 1.195–4.241 | 0.012 |
Criteria for choosing a specialty | |||||
Opportunity for research | −0.096 | 0.033 | 0.755 | 0.578–0.987 | 0.04 |
High salary | −0.207 | 0.002 | 0.580 | 0.376–0.893 | 0.013 |
Influency of spouse | 0.122 | 0.018 | |||
Specialty that deals with social issues | 0.146 | 0.004 | 1.442 | 1.079–1.927 | 0.013 |
Work only in the community | 0.278 | 0.001 | |||
Wide range of medical problems | 1.512 | 1.004–2.277 | 0.048 | ||
Criteria for choosing a residency program | r = 0.45 | ||||
Leading department | −0.125 | 0.053 | 0.581 | 0.395–0.854 | 0.006 |
Influence of family | 0.094 | 0.026 | 1.414 | 1.083–1.847 | 0.011 |
Short residency (< 4.5 years) | 0.159 | 0.001 | 1.524 | 1.122–2.069 | 0.007 |
Peripheral hospital | 0.188 | 0.001 | |||
Much supervision by senior physicians | 0.202 | 0.001 | 1.836 | 1.340–2.515 | 0.001 |
Much clinic time | 0.207 | 0.001 | 1.495 | 1.110–2.013 | 0.008 |
Interest in a residency in a peripheral hospital | r = 0.43 | ||||
Older age | 0.157 | 0.004 | 1.732 | 1.144–2.621 | 0.009 |
Have considered a specialty | −0.234 | 0.048 | |||
High school location (periphery) | 0.138 | 0.002 | 1.546 | 1.089–2.193 | 0.015 |
Criteria for choosing a specialty | |||||
Wide range of medical problems | 0.144 | 0.008 | |||
Time with family | 0.145 | 0.009 | 1.686 | 1.001–2.839 | 0.049 |
Work only in the community | 0.178 | 0.002 | 1.701 | 1.147–2.524 | 0.008 |
Influence of spouse | 1.488 | 1.019–2.173 | 0.039 | ||
Private practice | −0.109 | 0.012 | |||
Specialty that deals with social issues | 0.123 | 0.003 | |||
Narrow range of medical problems | 0.298 | 0.001 | 2.156 | 1.377–3.376 | 0.001 |
Criteria for choosing a residency program | r = 0.52 | ||||
Specific location in Israel | −0.106 | 0.031 | |||
Leading department | −0.280 | 0.001 | 0.480 | 0.091–0.791 | 0.004 |
Limited work hours | 0.108 | 0.031 | |||
Family living location | 0.115 | 0.046 | |||
Many on-call shifts | 0.121 | 0.011 | |||
Teaching students | 0.144 | 0.001 | 1.563 | 1.061–2.304 | 0.024 |
Physical challenge | 0.157 | 0.001 | |||
Primary care | 0.168 | 0.002 | |||
Much clinic time | 0.198 | 0.003 | 1.893 | 1.288–2.783 | 0.001 |
Much supervision by senior physicians | 0.045 | 1.010–2.455 | 0.045 | ||
Influence of family | 1.430 | 1.030–1.986 | 0.022 | ||
Monetary incentives for residency in the periphery | |||||
r - 0.58 | |||||
Opportunity for research | −0.126 | 0.047 | 0.580 | 0.360–0.933 | 0.025 |
Specialty advancing rapidly | −0.143 | 0.022 | 0.620 | 0.393–0.90 | 0.041 |
Specific location | −0.204 | 0.001 | 0.428 | 0.275–0.667 | 0.001 |
Primary care | 0.115 | 0.023 | |||
Specialty that deals with social issues | 0.126 | 0.008 | 1.530 | 1.044–2.242 | 0.029 |
Peripheral hospital | 0.258 | 0.001 | 2.835 | 1.782–4.511 | 0.001 |
Rural (periphery) workforce
Periphery | No periphery | Periphery vs no Periphery | ||
---|---|---|---|---|
N | 48 | 382 | ||
Gender | Female | 45% | 48% | |
Male | 55% | 52% | NS | |
Age (years) | 18–20 | 0% | 0.3% | |
21–23 | 17% | 18% | ||
24–26 | 19% | 30% | ||
27–29 | 42% | 39% | ||
30–32 | 17% | 10% | ||
+ 32 | 6% | 3% | NS | |
Marital status | Single | 63% | 71% | |
Married | 38% | 29% | ||
Divorced | 0% | 1% | NS | |
High school location | Israel | 100% | 97% | |
Other | 0% | 3% | NS | |
High school location in Israel | Jerusalem | 17% | 27% | |
Central | 31% | 42% | ||
North | 38% | 22% | ||
South | 15% | 8% | ||
Other | 0% | 1% | p < 0.05 | |
Residency location | Israel | 100% | 98% | |
Other | 0% | 2% | NS | |
Future residency location in Israel | Jerusalem | 13% | 26% | |
Central | 16% | 36% | ||
North | 40% | 7% | ||
South | 13% | 1% | ||
Don’t know | 18% | 31% | p < 0.01 | |
Specialties under consideration | Family medicne | 0% | 2% | |
Pediatrics | 46% | 30% | ||
Internal medicine | 24% | 32% | ||
Ob/Gyn | 15% | 21% | ||
Emergency medicine | 5% | 1% | ||
Surgical specialties | 32% | 30% | ||
Other specialties | 32% | 35% | p < 0.05 | |
Criteria for choosing a specialty | ||||
Time with family | 85% | 66% | p < 0.001 | |
Controllable lifestyle | 75% | 65% | p < 0.04 | |
Influency of spouse | 56% | 37% | p < 0.01 | |
Specialty that deals with social issues | 46% | 27% | p < 0.004 | |
Work only in the community | 19% | 3% | p < 0.001 | |
Narrow range of medical problems | 10% | 2% | p < 0.001 | |
Advancing rapidly | 48% | 62% | p < 0.05 | |
Opportunity for research | 29% | 41% | p < 0.03 | |
Criteria for choosing a residency program | ||||
Family living location | 81% | 69% | p < 0.04 | |
Teaching students | 57% | 40% | p < 0.05 | |
Pre-determined work hours | 56% | 41% | p < 0.05 | |
Influence of family | 52% | 33% | p < 0.02 | |
Much supervision bysenior physicians | 50% | 42% | p < 0.03 | |
Primary care | 42% | 15% | p < 0.0004 | |
Limited work hours | 42% | 21% | p < 0.03 | |
Much clinic time | 33% | 8% | p < 0.001 | |
Leading department | 58% | 79% | p < 0.0001 | |
Large hosptial | 47% | 60% | p < 0.003 |
Incentives
1. Incentive interests me | 2. Plan peripheral residency | 3. Incentives don’t interest me | 1 vs 3 | 1 vs 2 | 2 vs 3 | ||
---|---|---|---|---|---|---|---|
N | 106 | 20 | 223 | ||||
Percent | 30% | 6% | 64% | ||||
Gender | Female | 48% | 47% | 50% | |||
Male | 52% | 53% | 50% | NS | NS | NS | |
Age (years) |
18–20
| 0% | 0% | 0% | |||
21–23
| 22% | 20% | 19% | ||||
24–26
| 27% | 15% | 31% | ||||
27–29
| 36% | 50% | 35% | ||||
30–32
| 10% | 10% | 11% | ||||
+ 32
| 5% | 5% | 3% | NS | NS | p < 0.02 | |
Marital status | Single | 68% | 60% | 72% | |||
Married | 30% | 40% | 27% | ||||
Divorced | 2% | 0% | 1% | NS | p< 0.05 | p < 0.02 | |
High school location in Israel | Jerusalem | 27% | 5% | 25% | |||
Central | 36% | 32% | 40% | ||||
South | 10% | 26% | 10% | ||||
Other | 1% | 0% | 1% | NS | p < 0.01 | NS | |
Future residency location in Israel | Jerusalem | 14% | 10% | 29% | |||
Central | 20% | 0% | 41% | ||||
North | 14% | 55% | 8% | ||||
South | 0% | 20% | 1% | ||||
Don’t know | 53% | 15% | 22% | p< 0.03 | p < 0.01 | p< 0.01 | |
Specialties under consideration | Pediatrics | 39% | 31% | 31% | |||
Internal medicine | 21% | 6% | 35% | ||||
Ob/Gyn | 29% | 19% | 15% | ||||
Emergency medicine | 0% | 13% | 1% | ||||
Surgical specialties | 32% | 31% | 29% | ||||
Other specialties | 31% | 31% | 37% | p < 0.04 | p < 0.01 | p < 0.02 | |
Criteria for choosing a specialty | |||||||
Time with family (1) |
78%
| 60% | 63% | p < 0.004 | p < 0.04 | NS | |
Specialty that deals with social issues (3) |
35%
| 35% | 25% | p < 0.02 | NS | NS | |
Advancing rapidly (2) | 51% | 45% |
69%
| p < 0.0007 | NS | p < 0.04 | |
Opportunity for research (2) | 29% | 5% |
47%
| p < 0.0001 | p < 0.04 | p < 0.0001 | |
Controllable lifestyle (1) | 74% | 50% | 66% | NS | NS | NS | |
Independent practice | 54% | 40% | 51% | NS | p < 0.03 | p < 0.03 | |
High salary | 51% | 20% | 45% | NS | p < 0.006 | p < 0.01 | |
Procedures/surgery | 45% | 32% | 51% | NS | NS | p < 0.04 | |
Private practice | 37% | 10% | 404% | NS | p < 0.008 | p < 0.009 | |
Criteria for choosing a residency | |||||||
Controllable lifestyle |
73%
| 45% | 58% | p < 0.04 | p < 0.03 | NS | |
Primary care |
27%
| 32% | 15% | p < 0.001 | NS | p < 0.002 | |
Hospital in the periphery (3) |
8%
| 55% | 4% | p < 0.001 | p < 0.0007 | p < 0.001 | |
Intellectual challenge (1)a | 8% | 60% |
87%
| p < 0.004 | NS | p < 0.007 | |
Leading department (1)a | 69% | 45% |
85%
| p < 0.0002 | p < 0.004 | p < 0.0009 | |
Specific location | 51% | 68% |
70%
| p < 0.0001 | NS | NS | |
Large hospitial | 50% | 26% |
68%
| p < 0.005 | p < 0.04 | p < 0.0006 | |
Opportunity for research | 17% | 5% |
29%
| p < 0.02 | p < 0.01 | p < 0.0005 | |
Much supervision by senior physicians | 44% | 20% | 46% | NS | NS | p < 0.04 |