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.
career choice primary care residents generalists role models
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Fogelman AM. Strategies for training generalists and subspecialists. Ann Intern Med. 1994;120:579–83.PubMedGoogle Scholar
FCIM. Generating more generalists: an agenda of renewal for internal medicine. Ann Intern Med. 1993;119:1125–9.Google Scholar
AAMC Generalist Physician Task Force. AAMC policy on the generalist physician. Acad Med. 1993;68:1–5.CrossRefGoogle Scholar
Finberg L, Adler K, Cohen J, et al. Primary care in New York State: report and recommendations of the Associated Medical Schools of New York. NY State J Med. 1991;91:450–3.Google Scholar
Greer T, Carline JD. Specialty choice by medical students: recent graduate follow-up survey at the University of Washington. Fam Med. 1989;21:127–31.PubMedGoogle Scholar
Ramsdell JW. The timing of career decisions in internal medicine. J Med Educ. 1983;58:547–54.PubMedGoogle Scholar
Lieu TA, Schroeder SA, Altman DF. Specialty choices at one medical school: recent trends and analysis of predictive factors. Acad Med. 1989;64:622–9.PubMedCrossRefGoogle Scholar
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
McPhee SJ, Mitchell TF, Schroeder SA, Perez-Stable EJ, Bindman AB. Training in a primary care internal medicine residency program. JAMA. 1987;258:1491–5.PubMedCrossRefGoogle Scholar
Bland CJ, Meurer LN, Maldonado G. Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. Acad Med. 1995;70:620–41.PubMedCrossRefGoogle Scholar
Carline JD, Greer T. Comparing physicians’ specialty interests upon entering medical school with their eventual practice specialties. Acad Med. 1991;66:44–6.PubMedCrossRefGoogle Scholar
Hojat M, Gonnella JS, Erdmann JB, Veloski JJ, Xu G. Primary care and non-primary care physicians: a longitudinal study of their similarities, differences, and correlates before, during, and after medical school. Acad Med. 1995;70S:S17–28.CrossRefGoogle Scholar
Kebede R, Balint J, Pruzek R, Kremer S. The role of career pathway before medical school in graduates’ choice of primary care versus other specialty practices. Acad Med. 1995;70:723–5.PubMedCrossRefGoogle Scholar
Fincher RE, Lewis LA, Jackson TW, Specialty Choice Study Group. Why students choose a primary care or nonprimary care career. Am J Med. 1994;97:410–7.PubMedCrossRefGoogle Scholar
Solomon DJ, DiPette DJ. Specialty choice among students entering the fourth year of medical school. Am J Med Sci. 1994;308:284–8.PubMedCrossRefGoogle Scholar
Gorenflo DW, Ruffin MT, Sheets KJ. A multivariate model for specialty preference by medical students. J Fam Pract. 1994;39:570–6.PubMedGoogle Scholar
Petersdorf RG, Goitein L. The future of internal medicine. Ann Intern Med. 1993;119:1130–7.PubMedGoogle Scholar
McMurray JE, Schwartz MD, Genero NP, Linzer M. The attractiveness of internal medicine: a qualitative analysis of the experiences of female and male medical students. Ann Intern Med. 1993;119:812–8.PubMedGoogle Scholar