Journal of General Internal Medicine

, Volume 13, Issue 4, pp 257–261 | Cite as

What influences career choices among graduates of a primary care training program?

  • Dawn E. DeWitt
  • J. Randall Curtis
  • Wylie Burke
Original Articles


OBJECTIVE: To identify factors that influence primary care residents to become generalists or specialists.

DESIGN: Structured survey and interview.

SETTING: A large university-based, internal medicine residency program in primary care.

PARTICIPANTS: Of 92 residency graduates who completed training between 1979 and 1993, 88 (96%) participated.

MAIN RESULTS: Although 82% of the participating graduates reported themselves very committed to primary care at the beginning of residency, only 68% pursued generalist careers. Factors influencing career choice that were more important to generalists than specialists included breadth of knowledge used in primary care practice (p=.04), breadth of clinical problems in practice (p=.001), and opportunity for continuity of care (p=.01). Although salary was rated “not important,” 50% of generalists and specialists advocated increased salaries for generalists as a way to increase interest in primary care. Other promoting factors included mentors, increased prestige for generalists, community-based training, lifestyle changes, and decreased paperwork. Seventy-three percent of participants felt it was easier to be a specialist than a generalist.

CONCLUSIONS: A substantial minority of primary care residents pursue specialty careers. To produce more generalists, graduates recommend addressing income inequities, providing generalist role models, increasing community-based teaching, and increasing prestige for generalists.

Key words

career choice primary care residents generalists role models 


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Copyright information

© Society of General Internal Medicine 1998

Authors and Affiliations

  • Dawn E. DeWitt
    • 1
  • J. Randall Curtis
    • 2
  • Wylie Burke
    • 3
  1. 1.the Department of Medicine, Department of MedicineUniversity of WashingtonSeattle
  2. 2.Division of Pulmonary and Critical Care, Department of MedicineUniversity of WashingtonSeattle
  3. 3.Women’s Care Center, Department of MedicineUniversity of WashingtonSeattle

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