Conflicting evidence exists regarding whether SRC participation during medical school influences specialty choice^5,6,17,19,20. To address this gap, we conducted the largest single-cohort study to date, spanning 11 years across two medical schools. We found that SRC volunteers were significantly more likely to enter primary care specialties compared with non-volunteers. Volunteering was also associated with matching into higher-ranked residency programs and increased rates of induction into honor societies such as AOA and GHHS. A recent meta-analysis by Peoples et al.²⁷, which combined the results of this study with six other studies, found that volunteering at SRCs was associated with a higher likelihood of pursuing a primary care specialty. These findings provide new insights into how SRC participation may shape residency outcomes and highlight the potential role of volunteer experiences in supporting students’ career development.

The primary outcome of this study demonstrated that a significantly higher proportion of HOMES Clinic volunteers matched into primary care specialties. Within primary care, internal medicine and internal medicine-pediatrics emerged as the main drivers of this association. This pattern likely reflects two factors: (1) self-selection of students already inclined toward primary care and (2) the influence of SRC volunteering on students’ specialty choices. There exists a large overlap in scope and function between the HOMES Clinic and primary care, as SRCs typically emphasize primary and preventive care²⁸. While these results support the hypothesis that SRC participation can shape specialty decisions, prospective studies are needed to establish a causal relationship.

Most studies examining SRC volunteer outcomes have focused on primary care specialties, with limited evaluation of other medical fields²⁹. Our study also analyzed the relationship between SRC participation and matching into non-primary care specialties, and we found that HOMES volunteers showed an overall trend of reduced likelihood of choosing surgical specialties. These findings underscore the importance of expanding SRC research to include specialties beyond primary care, thereby broadening understanding of how SRC participation influences the full spectrum of medical specialty choices.

An exception to the overall trend in surgical specialties is the positive association between HOMES volunteers and matching into ophthalmology. This outcome likely reflects HOMES Clinic’s development of specific ophthalmology service opportunities in response to the disproportionate burden of vision-related conditions among homeless populations^30,31. HOMES Clinic established a weekly ophthalmology clinic, focused on screening, prevention, and referral, providing students with structured exposure, mentorship, and vocational identity development in this field. Given that mentorship is a well-documented factor influencing surgical career choice^32–35, the absence of comparable non-ophthalmologic surgical opportunities may contribute to students interested in other surgical fields seeking alternative avenues for mentorship.

Our findings underscore the importance of specialty representation at SRCs and the potential of expanding SRC volunteer opportunities to encompass a broader range of specialties. However, recommendations to expand specialty services at SRCs must acknowledge the complexities and challenges involved³⁶. Specialty clinics raise important ethical and logistical considerations, including ensuring adequate multi-disciplinary care, establishing competency standards for students, and addressing liability protections³⁷. Thus, while expansion of specialty representation offers educational opportunities, future efforts should be guided by careful consideration of these guidelines.

Examining honor society membership demonstrated that HOMES Clinic volunteers were more likely to be inducted into AOA and GHHS compared with non-volunteers. Both AOA and GHHS emphasize service, leadership, and compassionate patient care, suggesting that volunteering at HOMES Clinic provides meaningful opportunities to develop and demonstrate these qualities. These results are consistent with prior studies showing a positive association between SRC participation and honor society induction^15,38. Exposure to HOMES Clinic’s patient population, composed of individuals experiencing homelessness, heightens awareness of the social determinants of health. This visibility promotes discussion of complex social factors and fosters a deeper appreciation for their impact on patient care²⁸. Furthermore, manager training and the leadership responsibilities of clinical students at HOMES Clinic are additional opportunities to develop skills valued by both AOA and GHHS.

This study has several limitations. Its retrospective design introduces inherent selection bias, and causal relationships cannot be determined. Although SRC participation may influence students to pursue primary care, it is equally plausible that students with preexisting interest in primary care are more likely to volunteer. Because specialty choice is multifactorial³⁹, future work will track volunteers’ specialty preferences longitudinally to assess factors that influence changes in preference over time. In the absence of a standardized, objective residency ranking system, we used Doximity rankings as a surrogate for program reputation and research output. These rankings are derived from surveys of board-certified physicians on the Doximity platform but omit objective measures such as board pass rates, fellowship match rates, and research funding^25,40. Despite these methodological limitations, Doximity rankings demonstrably influence applicant decision-making and program reputation^40,41. In one survey of 2,152 applicants, 62% reported using Doximity during their application cycle, and 79% of these indicated that the rankings affected their rank lists⁴¹. Thus, although Doximity’s methodology has significant limitations, its clear influence on residency decision-making supports its use as a relevant ranking metric in this study.

In conclusion, our multi-institution retrospective analysis of 4,823 medical students found that a higher proportion of SRC volunteers matched into primary care specialties compared to non-volunteers. Sub-analyses further revealed that SRC volunteers had higher rates of induction into medical honor societies and were more likely to match into higher-ranked residency programs. These findings suggest that volunteering at an SRC may help shape medical students’ professional identity and provide a valuable opportunity to explore clinical interests, potentially influencing their career trajectories.