Associations between student social position, training, and plans to care for underserved populations over the course of medical school

There is a shortage of physicians ready to care for underserved communities in the United States. Given the American structure of Undergraduate Medical Education (UME) and Graduate Medical Education (GME), it is up to students to choose to care for underserved populations; medical school leaders may create programming to incentivize this choice, but that choice is ultimately up to students to make. Who, then, makes this choice? In this article, we examine a large, longitudinal dataset of multiple cohorts of medical students (2016-2020 through 2020-2024; N = 53,417) to identify patterns among which students plan to care primarily for underserved populations; we also investigate the factors that influence this choice over the course of medical school. Utilizing latent class analysis (LCA) and mixed-effect logistic regressions, we considered whether students' social and educational background influenced their choices at matriculation and graduation, as well as whether any courses or training experiences in medical school impacted their changed plans. We found that students from lower income, higher debt, and racially minoritized backgrounds were more likely to commit to caring for underserved populations compared to students from higher income, lower debt, and white backgrounds, who were more likely to not express such an intention. Additionally, we found that elective coursework oriented around underserved communities did not impact students’ likelihood to change their mind over the course of medical school to make this career choice. Our findings are important for informing medical school admissions and curricular policy, especially considering the physician shortage in underserved communities.