Importance The surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students’ intention to practice in underserved areas is unknown.

Objective To evaluate the association between students’ demographics and medical school experiences with intention to pursue surgery and practice in underserved areas.

Design, Setting, and Participants This cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020.

Main Outcomes and Measures Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students’ intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas.

Results Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ² P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas.

Conclusions and Relevance This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students’ motivation to practice in underserved areas.

重要性 外科劳动力短缺对促进医疗服务不足地区的健康公平构成威胁。尽管卫生资源和服务管理局和美国外科医生学院已呼吁增加受训人员的手术渠道以缓解这种短缺，但与学生在服务不足地区执业的意图相关的人口因素尚不清楚。

目的 评估学生的人口统计数据与医学院经历之间的关联，并打算在服务不足的地区进行手术和实践。

设计、设置和参与者 这项横断面研究调查了 2007-2008 年和 2011-2012 年入学的美国对抗疗法医学毕业生。分析从 2020 年 6 月开始，到 2020 年 12 月结束。

主要结果和措施 从美国医学院毕业调查问卷中检索到在服务欠缺地区进行手术和实践的意向。构建逻辑回归模型以评估（1）人口因素与医学生追求外科专业与医学专业的意图之间的关联，以及（2）人口因素与有意在服务不足地区执业的医学院选修课之间的关联。

结果 完成毕业问卷的57 307名学生中，48 096人（83.9%）人口学资料完整，被纳入研究队列。入学时的平均 (SD) 年龄为 23.4 (2.5) 岁。与报告有意从事非外科职业的学生相比，报告有意从事外科专业的学生被确定为女性的比例较低（3264 [32.4%] vs 19 731 [51.9%]；χ ²  P < .001)。与白人学生相比，多种族黑人和白人学生（调整优势比 [aOR]，1.72；95% CI，1.11-2.65）更有可能报告有手术意向。在报告打算进行手术的学生中，黑人/非裔美国学生（aOR，3.24；95% CI，2.49-4.22），西班牙裔学生（aOR，2.00；95% CI，1.61-2.47），多种族黑人和白人学生(aOR, 2.27; 95% CI, 1.03-5.01) 和印度/巴基斯坦学生 (aOR, 1.31; 95% CI, 1.02-1.69) 比白人学生更有可能报告在服务欠缺地区执业的意愿。报告参与社区健康（aOR，1.61；95% CI，1.42-1.83）或全球健康（aOR，1.83；95% CI，1.61-2.07）经验的学生更有可能报告有在服务不足地区执业的意愿。

结论和相关性 本研究表明，使外科培训渠道多样化并将健康差异和社区健康纳入本科或研究生医学教育可能会促进学生在服务不足地区执业的动力。