A recent survey of third- and fourth-year medical students revealed that their intention to practice in underserved areas is influenced by factors such as growing up in medically underserved settings, previous work experience in religiously affiliated organizations, a very strong sense of calling, and high medical school social mission scores.1

“Caring for the medically underserved remains a pressing need in our shifting healthcare environment,” says John D. Yoon, MD, one of the study’s authors. Yoon is associate program director of the internal medicine residency program at Mercy Hospital and Medical Center in Chicago, and associate faculty of the MacLean Center for Clinical Medical Ethics at the University of Chicago.

Of the 474 students who responded to a follow-up survey, 34% had an intention to practice among the underserved.

“The ability of physicians to derive intrinsic meaning from their work may be an important factor influencing long-term workforce retention when caring for the underserved,” says Yoon.

Physicians will encounter challenges that test their commitment. These include high educational debt, lack of positive role models, and exposure during training to the often chaotic work environments of underresourced clinics and hospitals.

“When push comes to shove, physicians will by default rely on their deepest commitments and their inner resources,” says Yoon.

The study is part of the University of Chicago’s Project on the Good Physician, a research initiative on the ethical and professional development of physicians in training.

“A growing number of critics argue that conventional, didactic approaches fall far short of helping physicians develop the moral characteristics essential for good medical practice,” says Yoon.

In this particular study, the researchers wanted to learn more about how a medical student becomes a physician “who finds enduring meaning and intrinsic reward in the sort of clinical practice that meets the pressing needs of the United States public,” says Yoon.

The researchers noticed a “glaring gap” in the medical literature on the role of religion and spirituality. “We did find that more religious medical students were more likely to report intentions to enter primary care in underserved settings,” says Yoon.

However, the majority of medical students have no intentions of practicing among the underserved. This is the case despite a physician shortage that disproportionately affects this population.

“Our study highlights the important role that institutional cultures of academic medical centers might have in training the kind of physicians who are committed to caring for the underserved,” concludes Yoon.

Physicians strongly committed to caring for the underserved act as role models for trainees. “I suspect that these cultures will have an immense long-term influence on whether trainees choose careers that care for the underserved,” says Yoon.


1. O’Connell TF, Ham SA, Hart TG, et al. A national longitudinal survey of medical students’ intentions to practice among the underserved. Acad Med 2018; 93(1):90-97.


• John D. Yoon, MD, Associate Faculty, MacLean Center for Clinical Medical Ethics, University of Chicago. Phone: (773)702-5197. Email: jdyoon@uchicago.edu.