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What Makes a Medical Student Want to Work for Free?

How psychology can help predict and promote medical pro bono work.

National Cancer Institute (Unsplash)
Source: National Cancer Institute (Unsplash)

By Joshua Braverman (PhD candidate), Department of Psychology, University of Minnesota Twin Cities

The United States has the highest out-of-pocket healthcare costs in the world, per capita ($10,948). It's followed by Switzerland ($7,138), Norway ($6,748), and Germany ($6,730). When compared to the 2019 annual median income of $35,977, many people in the United States of America could be expected to pay almost a third (or more) of their income in out-of-pocket healthcare costs.

As a Licensed Practical Nurse (LPN), I have seen first-hand the impacts of healthcare needs being unmet due to patients’ inability to afford or access the care. A frequent and tragic example of unmet healthcare needs is when a patient must put off preventative health screenings for so long that a potentially curable disease is discovered too late.

How might we, as a society, address unmet health care needs? There are a number of ways we could approach solving this problem. One is to encourage medical professionals to provide no (or low) cost medical services, termed “medical pro bono.” With a better understanding of the psychological processes that may lead to taking part in medical pro bono work, we can begin to effectively promote medical pro bono to the most interested medical professionals.

Are the Most Altruistic Medical Students Always the Most Prosocial?

Medical students, as future medical professionals, can and do take part in medical pro bono service. In addition, medical school is a foundational time for future physicians. As such, we felt medical school was an important period during which to examine medical pro bono work. In late 2020, research collaborators and I examined whether psychological or social factors predicted medical pro bono work in a sample of medical students. Through a survey, students told us about their involvement in medical pro bono work, personality, motivations, various aspects of their identity, and how they viewed the expectations of those around them.

In our recently published article, "Psychological predictors of medical students’ involvement in pro bono" published in the journal Teaching and Learning in Medicine, we were surprised to discover that several factors we expected to strongly predict intentions to get involved with medical pro bono work were not predictors. Neither personality nor one's motivations were substantially relevant to understanding medical pro bono intentions. Neither was being involved with non-medical volunteerism, nor plans for future non-medical volunteering. What does this mean? These unexpected results seem to suggest that intentions towards medical pro bono work are more than simply a specific version of planned volunteerism. And, contrary to much of the scholarly conversations in medical education, individual differences in motivation and personality (such as agreeableness or openness to experience) did not predict intentions towards medical pro bono work.

However, we found that aspects of medical students’ identity and others' expectations of the medical students were both highly predictive of medical students’ pro bono intentions. For identity, we found that those students who consider taking part in medical pro bono work to be a key aspect of who they are—both as a medical student and as a future doctor—expressed higher medical pro bono intentions. Also, those who perceived that their professors, peers, and personal connections valued or expected involvement in medical pro bono expressed higher intentions to do so.

We conclude that situational forces are likely to be more relevant for understanding medical students’ intentions towards medical pro bono. In particular, incorporating medical pro bono into one’s identity and expectations is crucial. For example, it is important for medical students to observe their peers and professors taking part in medical pro bono. In addition, when medical schools encourage students to take part in medical pro bono and make the necessary investment of resources, it can demonstrate how much the institution values medical pro bono.

Looking Forward: Turning Research Results into Real World Results

Barring drastic changes in the United States' healthcare system, innovative solutions will be necessary to address unmet healthcare needs. One possible approach is leveraging medical pro bono work to provide low or no cost healthcare to those who are unable to afford such care. While systemic change will be necessary to address large-scale healthcare needs, medical pro bono work can be implemented by one or more medical professionals. Leveraging the psychological predictors of intentions towards medical pro bono work might be useful to promote such behavior. Once we understand the underlying mechanisms, researchers and practitioners alike may begin to effectively promote medical pro bono among medical students and practicing physicians alike.

Our research findings provide insights applicable to individual medical students and medical education more broadly. To change individual actions, persuasive messaging can target psychological constructs—such as identity—relevant to medical pro bono. These messages could take the form of messages about social norms (e.g., “83 percent of medical faculty and 92 percent of medical students at our university believe that students should take part in medical pro bono work during and after their formal medical education”).

As medical students also need to perceive that they have the ability to take part in medical pro bono work (if they were to choose to), providing information and instrumental assistance about medical pro bono is likely to boost the effectiveness of any individual-level persuasive intervention. An example of this kind of message could be: “Our Office of Community Engagement operates a student-run medical clinic, maintains a list of medical pro bono opportunities in our community, and offers one-on-one consulting to interested students.”

Medical school administrators should aim to develop students into professionals who value and take part in medical pro bono during and after their formal medical education. Through formal structures, this could include investing resources and staff to facilitate medical pro bono opportunities at the program level. By helping to overcome the logistical barriers of participation, perceived behavioral control is likely to be elevated, promoting involvement in medical pro bono work.

Perhaps even more important, medical faculty and administrators need to lead by example and let their actions demonstrate how important it is for doctors to use medical knowledge and training to help those in need (and who can’t access care due to cost). Doing so will help budding doctors incorporate involvement in medical pro bono into their identity as a physician as well as understand any implied expectation to take such actions. These small changes to medical school culture can have an oversized impact on those who have unmet health care needs.

Edited By: Ashley M. Votruba, J.D., Ph.D., SPSSI Blog Editor, Assistant Professor, University of Nebraska - Lincoln


Braverman, J., & Snyder, M. (2022). Psychological predictors of medical students’ involvement in pro bono. Teaching and Learning in Medicine, 1–13.

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