ACADEMIAS CHILLY CLIMATE FOR PRIMARY-CARE

Objective.-To describe the attitudes toward and perceptions of primary care education and practice among academic health center constituents . Design and Participants.-Descriptive study using confidential teleph one interviews (October 1993 to March 1994) of national stratified pro bability samples of first- and fourth-year medical students, residents , clinical faculty, internal medicine and pediatrics residency trainin g directors and chairs, and deans (N=2293). Results.-Five areas were e xamined: respondents' specialty orientation, attitudes toward the comp etence of primary care physicians, encouragement and positive regard f or primary care, exposure to primary care-related educational experien ces, and socioemotional orientation. The response rate was 84%. Respon dents generally perceive primary care tasks as not requiring high leve ls of expertise; nearly half believe that generalists are not the best physicians to manage patients with serious illness and that the quali ty of primary care research is inferior to that in other fields. Attit udes are more positive toward the quality of primary care teaching. Le arners perceive little encouragement for generalist careers and negati ve attitudes toward generalists among faculty, and view the quality of their primary care training as inferior to that for specialty practic e. Those who have progressed further in the academic medicine hierarch y generally report lower levels of socioemotional orientation than ind ividuals at earlier phases of career development. Conclusions.-Despite changes in the health care system and in education, students and resi dents encounter an atmosphere that is chilly toward primary care. If m edical educators seek to optimize enthusiasm and preparation for prima ry care careers, they must develop approaches to. changing the attitud es, values, and composition of their faculties.