Abstract
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.
Similar content being viewed by others
References
Fogelman AM. Strategies for training generalists and subspecialists. Ann Intern Med. 1994;120:579–83.
FCIM. Generating more generalists: an agenda of renewal for internal medicine. Ann Intern Med. 1993;119:1125–9.
AAMC Generalist Physician Task Force. AAMC policy on the generalist physician. Acad Med. 1993;68:1–5.
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.
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.
Ramsdell JW. The timing of career decisions in internal medicine. J Med Educ. 1983;58:547–54.
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.
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.
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.
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.
Carline JD, Greer T. Comparing physicians’ specialty interests upon entering medical school with their eventual practice specialties. Acad Med. 1991;66:44–6.
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.
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.
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.
Solomon DJ, DiPette DJ. Specialty choice among students entering the fourth year of medical school. Am J Med Sci. 1994;308:284–8.
Gorenflo DW, Ruffin MT, Sheets KJ. A multivariate model for specialty preference by medical students. J Fam Pract. 1994;39:570–6.
Petersdorf RG, Goitein L. The future of internal medicine. Ann Intern Med. 1993;119:1130–7.
Petersdorf RG. Commentary: primary care-medical students’ unpopular choice. Am J Public Health. 1993;83:328–30.
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.
Schultz HS. Letter to the editors. Ann Intern Med. 1994;120:526.
Hale FA, Abyad A. Disagreements between students and preceptors in assessing students’ interest in primary care. Acad Med. 1993;68:902.
Seifer SD, Troupin B, Rubenfeld GD. Changes in marketplace demand for physicians: a study of medical journal recruitment advertisements. JAMA. 1996;276:695–9.
Author information
Authors and Affiliations
Additional information
Supported in part by Public Health Service training grant D 28 PE 10061.
Rights and permissions
About this article
Cite this article
DeWitt, D.E., Curtis, J.R. & Burke, W. What influences career choices among graduates of a primary care training program?. J GEN INTERN MED 13, 257–261 (1998). https://doi.org/10.1046/j.1525-1497.1998.00076.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.1998.00076.x