Abstract:

Background:
Fewer students are moving into primary care and the retention of primary care physicians in medically underserved communities is declining. Many medical students desire to be in esteemed specialties and do not perceive primary care to be a field that is well respected. Moreover, medical students may be influenced by the opinions of their colleagues, teachers, and role models. Also, the attitudes toward caring for immigrants and refugees may be influenced by gender role norms and expectations. However, few studies have addressed gender influences on intent to work with immigrants and patients in underserved and/or rural areas.

Methods:
We explored the association between gender and choice for future medical practice specialty, particularly with intent to care for uninsured, immigrant, refugee, and underserved populations. We hypothesized that the gender and choice of future medical practice specialty will be associated with medical students’ intent to work with the underserved as a career choice. A cross-sectional, correlational design was used to collect data from medical students (N=239) in a large medical school in south Florida, United States. Students completed the "Medical Student Attitudes toward the Underserved" questionnaire. The questionnaire contained items on participants’ personal characteristics, intentions to work with underserved, and future practice interests. Chi-square tests were performed using SPSS software.

Results:
The sample had 123 (51%) men and 116 (49%) women aged 20-47 years (M=24 years). About half were White (n=132; 55.2%); the rest were Asian/Pacific Islander (n =54; 22.5%), Black (n=17; 7.1%), and Hispanic (n=48; 24%). A relationship was found between gender and intentions to work with the underserved, x2(1, N=237) = 12.07, p<.01, with higher intentions to work with the underserved associated with being female (59.2% vs. 40.8%). Additional chi-square tests indicated a relationship between gender and future medical specialty practice choices. Choice of pediatrics as a future medical specialty practice choice was associated with more intent to work with underserved (78.6% vs. 21.4%), x2 (1, N=237) = 21.1, p<.01. Surgical medicine as a future career choice was associated with less intent to work with underserved (74.2 vs. 25.8%), x2 (1, N=237) = 5.42, p<.01.

Conclusion:
Male students who have negative attitudes toward underserved populations may lack an understanding of these populations and the personal, cultural, and societal factors that affect health and health outcomes. Male students may have negative attitudes toward underserved populations due to social norms related to gender, insufficient role models, and the desire for more prestigious, high paying jobs. The gender of medical students might influence not only future career choice but in their future intentions to work in medically underserved, refugee and immigrant communities, where the need is great. Findings from this study could help guide academic programming efforts that encourage all students to pursue health careers in underserved areas where the need is great.

Keywords:

Gender disparity, immigrant, underserved, medical education, curriculum development.