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PURPOSE: To identify previously unrecognized factors influencing medical students' career choices and to better characterize the effects of educational experiences, role models, and educational debt on career decisions. METHOD: Fifty-two third- and fourth-year students were recruited from three California medical schools to participate in focus-group discussions. The students were assembled into 12 groups of about four classmates from the same school, each facilitated by a medical student from another school. Focus-group discussions were audiotaped and qualitatively analyzed using content analysis. RESULTS: The students' perceptions of their abilities to influence patients' outcomes and to cope with a large knowledge base differentiated those interested in primary care fields from those attracted to procedure-oriented specialties. Negative role models, based on the students' assessments of interpersonal interactions and career satisfaction, were particularly influential in closing doors to certain fields. Many of the women reported an absence of role models. Most of the students denied any effect of debt or potential income on career choice; while many cited their small debts, some of the women alluded to the anticipation of being in dual-income families. CONCLUSION: Students' career decisions are complex, dynamic, and individualized processes. The use of qualitative measures helps bolster understanding of these processes by identifying new factors (such as mastery of knowledge) and by further characterizing known factors (such as role models and financial considerations). A comprehensive and valid understanding of students' career-decision making is necessary to develop successful strategies to sustain and encourage the choice of primary care careers.