What influences Harvard Medical School (HMS) students to pursue a career in primary care? In our study, we surveyed HMS graduates from 1980 to 2016 who matched into internal medicine, family medicine, and pediatrics residencies to dig deep into this question.

We learned that three out of four students who started HMS with an interest in primary care stuck with their goal. Over the 37 years, the proportion of incoming students with an interest in primary care remained steady at 50-60%. Of all primary care physicians, nine out of ten would choose this career again and would recommend a career in primary care to current students.

Both primary care and non-primary care physicians ranked “approach to care (specialist vs. generalist)” as one of the top three factors that influenced their career choice. Primary care physicians deemed “long-term relationships with patients” and “unmet need of patient populations” to be of high influence while non-primary care physicians were driven by “attitudes of mentors or educators in residency” and “research opportunities.”

Free response answers further enriched our understanding of significant drivers of primary care career choice. These insights emerged across several themes, such as perceptions of primary care and systemic challenges. For example, respondents highlighted that mentors played a key role in career selection:

• “Without positive primary care role models and those who supported primary care [as] a rigorous, valuable career choice it would have been much harder to counteract the negative culture towards primary care ingrained in specialty-focused quaternary care settings.”
  
  
• “When I was at HMS there were few mentors and little encouragement for this, you were considered less smart or worthy if [you] showed interest in primary care and valued only if doing surgery, medicine or focused on research.”
  
  

Respondents also identified challenges outside of the HMS campus and inherent to the healthcare system, including difficult time constraints, administrative burdens, and issues with compensation.

Given the impending shortage of primary care physicians in the United States, our findings outlined the manuscript are especially relevant as they identify potential areas of intervention for increasing the percentage of students choosing a primary care career.

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**Paulius Mui is a third year medical student in the Family Medicine Scholars Training and Admission Track (fmSTAT) at Virginia Commonwealth University School of Medicine.