WHAT INFLUENCES CAREER CHOICES AMONG GRADUATES OF A PRIMARY-CARE TRAINING-PROGRAM

OBJECTIVE: To identify factors that influence primary care residents t o become generalists or specialists. DESIGN: Structured survey and int erview. 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 themselv es 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 clini cal problems in practice (p = .001), and opportunity for continuity of care (p = .01), Although salary was rated ''not important,'' 50% of g eneralists and specialists advocated increased salaries for generalist s as a way to increase interest in primary care. Other promoting facto rs included mentors, increased prestige for generalists, community-bas ed 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 reside nts pursue specialty careers. To produce more generalists, graduates r ecommend addressing income inequities, providing generalist role model s, increasing community-based teaching, and increasing prestige for ge neralists.