A primary care (PC) pathway was initiated within the medical residency program at Boston City Hospital (BCH) in 1974. The authors studied the PC and traditional (TD) track graduates of the program to compare career development, goals, and practice patterns. The 185 graduates of the nine resident cohorts from 1974 through 1983 were surveyed; the overall response rate was 74%. Primary care careers have been chosen by 81% of PC graduates, compared with 38% of TD graduates (p<0.001); career satisfaction is equally high in the two groups. Among the PC graduates, 68% are practicing in high-need areas, compared with only 37% of TD graduates (p<0.001). PC graduates are more likely to make house calls, provide extended office hours, round in nursing homes or chronic care facilities, and co-practice with nurse practitioners or physician’s assistants, and they are more active in women’s health care, care of the terminally ill, and treating patients with sexual dysfunction (all p<0.05). PC graduates utilize various community agencies more frequently and supplement patient education with outside resources more intensively (p<0.001). The career choices and practice locations of PC graduates reflect the training goals of the PC curriculum and differ from the career choices and practices of the TD graduates from the same program.