Journal of General Internal Medicine

, Volume 9, Supplement 1, pp S81–S89 | Cite as

Innovative generalist programs

Academic health care centers respond to the shortage of generalist physicians
  • Christopher Urbina
  • Martin Hickey
  • Caryn Mcharney-Brown
  • Stewart Duban
  • Arthur Kaufman


Academic health care centers increasingly are exploring innovative ways to increase the supply of generalist physicians. The authors review successful innovations at representative academic health centers in the areas of recruitment and admissions, undergraduate medical education, residency training, and practice support. Lessons learned focus on those areas that have demonstrated improvements in the number and quality of physicians trained in family practice, general pediatrics, and general internal medicine. Successful recruitment of generalism-oriented applicants requires identification and tracking of rural, minority, and other special groups of students at the high school and college levels. Academic health care centers that provide early, sustained, community-based, ambulatory experiences for medical students and residents encourage trainees to maintain and choose generalist careers. Finally, academic health care centers that link with community providers and with state government encourage the retention of generalist physicians through continuing education and teaching networks.

Key words

academic health care centers generalist training 


  1. 1.
    Melnick A. Osteopathic medicine and primary care practice: plan or serendipity? Acad Med. 1990;65 (12 suppl):S87-S89.PubMedCrossRefGoogle Scholar
  2. 2.
    O’Neill EH, Seifer SD, Kahn JB. Rural Health: Implications for Education and Workforce Policy. Presented at Implementing Health Care Reform in Rural America. Center for the Health Professions, University of California, San Francisco, San Francisco: Dec. 1993.Google Scholar
  3. 3.
    Babbott D, Levey GS, Weaver SO, Killian CD Medical student attitudes about internal medicine: a study of US medical school seniors in 1988. Ann Intern Med. 1991;114:16–22.PubMedGoogle Scholar
  4. 4.
    Babbott D, Baldwin DC, Killian CD, Weaver SO. Trends in evolution of specialty choice: comparison of US medical school graduates in 1983 and 1987. JAMA. 1989;261:2367–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Babbott D, Baldwin DC, Jolly P, Williams DJ. The stability of early specialty preferences among US medical school graduates in 1983. JAMA. 1988;259:1970–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Rabinowitz HK. Evaluation of a selective medical school admissions policy to increase the number of family physicians in rural and underserved areas. N Engl J Med. 1988;319:480–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Carline JD, Green T. Comparing physicians’ specialty interests upon entering medical school with their eventual practice specialties. Acad Med. 1991;66:44–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Kassler WJ, Wartman S, Silliman RA. Why medical students choose primary care careers. Acad Med. 1991;66:41–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Rezler AG, Kalishman SG. Who goes into family medicine? J Fam Pract. 1989;29:652–6.PubMedGoogle Scholar
  10. 10.
    Coffin SE, Babbott D. Early and final preferences for pediatrics as a specialty; a study of US medical school graduates in 1983. Acad Med. 1989;64:600–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Ernst RL, Yett. Physician Location and Specialty Choice. Ann Arbor, MI. Health Administration Press, 1985.Google Scholar
  12. 12.
    Krnus AS, Botterell EH, Einarson DW, Thompson MG. Initial career plan and subsequent family practice. J Med Educ. 1971;46:826–30.Google Scholar
  13. 13.
    Project “3000 by 2000”: Technical Assistance Manual—Guidelines for Action. Washington, DC: Association of American Medical Colleges, April 1992.Google Scholar
  14. 14.
    Rabinowitz HK Presentation for the Robert Wood Johnson Generalist Physician Initiative, Jan 1993, Fort Lauderdale, Florida.Google Scholar
  15. 15.
    Moore G. Personal communication, 1993.Google Scholar
  16. 16.
    Evans DA, Jones PK, Wortam RA, et al. Traditional criteria as predictors of minority student success in medical school. J Med Educ. 1975;50:934–9.PubMedGoogle Scholar
  17. 17.
    Rabinowitz HK. Evaluation of a selective medical school admissions policy to increase the number of family physicians in rural and underserved areas. N Engl J Med. 1988;319:480–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Vanselow NA. Medical education and the rural health crisis: a personal perspective from experiences in five states. Acad Med. 1990;65(12 suppl):S27-S31.PubMedCrossRefGoogle Scholar
  19. 19.
    Brazeau NK, Potts MJ, Hickner JM. The Upper Peninsula Program: successful model for increasing primary care physicians in rural areas. Fam Med. 1990;22:350–5.PubMedGoogle Scholar
  20. 20.
    Verby JE, Newell JP, Andersen SA, Swentko WS. Changing the medical school curriculum to improve patient access to primary care. JAMA. 1991;266:110–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Verby JE, Schaefer MT, Voeks RS. Learning forestry out of the lumberyard. JAMA. 1981;246:645–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Kaufman A, Mennin S, Waterman R, et al. The New Mexico Experiment: education innovation and institutional change. Acad Med. 1989;64:285–94.PubMedCrossRefGoogle Scholar
  23. 23.
    Mines J. University of New Mexico School of Medicine Longitudinal Project, personal communication, 1994.Google Scholar
  24. 24.
    Mennin S. University of New Mexico School of Medicine Longitudinal Project, personal communication, 1994.Google Scholar
  25. 25.
    Urbina C, McGrew MC, Kaufman A. A new curriculum. J Minority Med Stud. Fall 1993;32–35.Google Scholar
  26. 26.
    Hansen LA, Talley RC. South Dakota’s third-year program of integrated clerkships in ambulatory care settings. Acad Med. 1992;67:817–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Kassebaum DG, Haynes RA. Relationship between third-year clerkships in family medicine and graduating students’ choices of family practice careers. Acad Med. 1992;67:217–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Stine CC, Sheets KJ, Caconge BN. Association between clinical experiences in family practice or in family care and the percentage of graduates entering family practice residencies. Acad Med. 1992;67:475–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Rabinowitz HK. The relationship between medical student career choice and a required third year family practice clerkship. Fam Med. 1988;20:118–21.PubMedGoogle Scholar
  30. 30.
    Whitcomb ME, Cullen TJ, Hart LG, Lishner DM, Rosenblatt RA. Comparing the characteristics of schools that produce high percentages and low percentages of primary care physicians. Acad Med. 1992;67:587–92.PubMedCrossRefGoogle Scholar
  31. 31.
    Schroeder S, Showstack J, Gerbert B. Residency training in internal medicine: time for a change? Ann Intern Med. 1986;104:554–61.PubMedGoogle Scholar
  32. 32.
    Nuckolls J. Internal medicine practice in transition. Implications for curriculum changes. Ann Intern Med. 1992;116:1051–4.PubMedGoogle Scholar
  33. 33.
    Cohen J. Roles of various organizations in internal medicine curriculum reform. Ann Intern Med. 1992;116:1111–5.PubMedGoogle Scholar
  34. 34.
    Montague J. Precision maneuvers: a recent survey finds group practices are gearing up for reform and system integration. Hosp Health Care Networks. 1994;68(1):26–33.Google Scholar
  35. 35.
    Strelnick A, Bateman W, Jones C, et al. Graduate primary care training: a collaborative alternative for family practice, internal medicine, and pediatrics. Ann Intern Med. 1988;109:324–34.PubMedGoogle Scholar
  36. 36.
    Dale D, Wallace J, Clark H, Rockey P, Featherstone H, Petersdorf R. Restructuring an internal medicine residency program to meet regional and national needs for general internists. Am J Med. 1981;70:1085–90.PubMedCrossRefGoogle Scholar
  37. 37.
    Philbrick JT, Connelly JE, Corbett EC, et al. Restoring balance to internal medicine training: the case for the teaching office practice. Am J Med Sci. 1990;229:43–9.CrossRefGoogle Scholar
  38. 38.
    Sargent JR, Osborn LM. Resident training in community pediatrician’s offices. Am J Dis Child. 1990;144:1356–9.PubMedGoogle Scholar
  39. 39.
    Moore GT. Health maintenance organizations and medical education: breaking the barriers. Acad Med. 1990;65:427–32.PubMedCrossRefGoogle Scholar
  40. 40.
    Moore GT, Inui TS, Ludden JM, Schoenbaum SC. Personal communication, 1994.Google Scholar
  41. 41.
    Erney SL, Allen DL, Siska KF. Effect of year-long primary care clerkship on graduates’ selection of family practice residencies. Acad Med. 1991;66:234–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Rucker L, Morgan C, Ward KE, Bell BM. Impact of an ambulatory care clerkship on the attitudes of students from five classes (1985–1989) toward primary care. Acad Med. 1991;66:620–2.PubMedCrossRefGoogle Scholar
  43. 43.
    McPhee SJ, Mitchell TF, Schroeder SA, Perez-Stable EJ, Bindman AB. Training in a primary care internal medicine residency program: the first ten years. JAMA. 1987;258:1491–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Quill TE. Medical resident education: a cross-sectional study of the influence of the ambulatory preceptor as a role model. Arch Intern Med. 1987;147:471–97.CrossRefGoogle Scholar
  45. 45.
    Philbrick JT, Connelly JE, Corbett EC, et al. Restoring balance to internal medicine training: the case for the teaching office practice. Am J Med Sci. 1990;299:43–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Napodano JJ, Schuster BL, Krackov SK, Young E, Griner PF, Pratt R. Use of private offices in education of residents in internal medicine. Arch Intern Med. 1984;149:303–5.CrossRefGoogle Scholar
  47. 47.
    1989 Progress Report. North Carolina Area Health Education Centers Program, Chapel Hill, NC.Google Scholar
  48. 48.
    Kaufman A, Waterman RE (eds). 1993 Health of the Public: a challenge to academic health centers—strategies for reorienting academic health centers toward community health needs. San Francisco: Health of the Public Program, 1993.Google Scholar

Copyright information

© Society of General Internal Medicine 1994

Authors and Affiliations

  • Christopher Urbina
    • 1
  • Martin Hickey
    • 2
  • Caryn Mcharney-Brown
    • 1
  • Stewart Duban
    • 3
  • Arthur Kaufman
    • 1
  1. 1.the Department of Family and Community MedicineUniversity of New Mexico School of MedicineAlbuquerque
  2. 2.Department of Internal MedicineUniversity of New Mexico School of MedicineAlbuquerque
  3. 3.Department of PediatricsUniversity of New Mexico School of MedicineAlbuquerque

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