The survey participants revealed a similar distribution of age and gender to a national sample of recent medical school graduates in Japan [15]. Among the study participants, general practice was selected as one of the career options by approximately 32% of medical students in their final year. “Clinical diagnostic reasoning”, “community-oriented practice”, and “involvement in preventive medicine” were positively associated with the selection of general practice. A student’s community orientation has been shown to predict primary care career preference and was a factor affecting family medicine career choice among Japanese physicians [11]. On the contrary, the ranking of “acute care rather than chronic care”, “mastering advanced procedures”, and “depth rather than breadth of practice” as of higher importance were less likely to be associated with an aspiration for general practice aspiration. This has been described in other studies [13].
Of 14 career priorities, “clinical diagnostic reasoning” was the strongest predictor of general practice choice, a finding not common in previous literatures. In many Japanese medical schools, the department of general practice or family medicine has been in charge of teaching fundamental clinical reasoning skills to medical students. Such context could have contributed to the strong positive association between clinical diagnostic reasoning and general practice choice among study participants.
Two demographic factors, “having physician parent” and “plan to inherit other’s practice”, were found to have significant association with choosing general practice, even after controlling for other covariates. Having physician parent was negatively associated with general practice choice, which is concordant with existing literature [6, 7] from North America and Europe. One potential reason is that the perceived prestige of other medical specialties among physician parents could negatively influence their children’s general practice choice. On the other hand, having family or friends in general practice was found to have positive association with general practice career choice in a study [15]. Thus, it is possible that the effect of family physicians may vary according to the specialty of parents. A positive association between the intention to inherit existing practice and general practice choice would have reflected students’ perceived usefulness of general practice residency to develop expertise as a future private practice owner.
Some previously known demographic factors, such as being female [2,3,4,5] and coming from rural background [2, 5, 6], had no association between students’ general practice choice. In our study, participants were asked to select the degree of rurality of their birthplace based on subjective judgment. This could be attributed to the heterogeneity of birthplace classification, which potentially could have led to a null result. In addition, the different definition of rural areas among countries should be taken into consideration for future research.
The role of gender in career choice has been well studied and is known to be affected by nationality. A qualitative study explored Japanese female doctors’ perspectives on specialty choice and found that they tend to make a choice based on conventional gender roles where women tend to spend more time on household duties [16]. It is possible that general practice, which is not well-established yet in Japan, could have been perceived as too unpredictable and insecure a career path. Such insecurities of general practice career could have been perceived as an unreasonable choice for female medical students. While family medicine preference at entry to medical school is known to increase the likelihood of choosing a family medicine career [7, 8], this item was not included in our study as we assumed that a general practice career path had not been widely available at the time of study participants’ medical school entry.
Our results reflect how general practice is perceived by medical students, and they are a little different from that in other countries where general practice/family medicine is well-established. Further studies are required to confirm factors affecting students’ career choice to determine strategies to facilitate general practice career choice in Japan.
Limitations
Despite the thorough development of the questionnaire and relatively large sample size, our study has several limitations. First of all, our outcome measurement was career aspiration during the final year of medical school. Thus, the actual enrolment in general practice residency and subsequent retention rate should also be considered in the future. Secondly, due to convenience sampling of medical schools, the representativeness of our study results to the general medical student population would be limited. In addition, the study results may not be generalizable to other countries. To our knowledge, however, this is the first and largest nationwide survey conducted across multiple Japanese medical schools.