RETRAINING PHYSICIANS FOR PRIMARY-CARE - A STUDY OF PHYSICIAN PERSPECTIVES AND PROGRAM-DEVELOPMENT

Objective.-To determine the number and kinds of programs that medical schools and managed care organizations offer or plan to offer to retra in physician specialists to practice primary care medicine and to disc over physicians' attitudes toward such retraining. Design.-A survey wa s mailed in 1994 to all 126 medical schools and the 19 largest US mana ged care organizations to collect detailed information about existing and potential retraining programs, Physicians' attitudes toward retrai ning were elicited from participants in 3 geographically diverse focus groups, Selected specialists were polled through the national survey of the American Medical Association's Socioeconomic Monitoring System to ascertain the demand for retraining. Results.-The majority of insti tutions contacted perceived a need for retraining, but few programs ha d been established, Programs being ''considered'' varied widely in dur ation, class size, target audience accreditation, and projected traini ng settings. Although unenthusiastic about retraining, physicians pref erred programs that would expand their patient base, maintain the prac tice population, be inexpensive and close to home, and provide hands-o n training in the eventual practice environment. Physicians also prefe rred a goal-oriented, part-time retraining program in a large group pr actice or managed care setting that would allow them to practice their specialty while retraining. Few planned or existing programs incorpor ate many of these features, The most likely candidates for retraining are subspecialty physicians who currently provide some primary care an d are employed by a medical plan. Conclusions.-Despite efforts by thos e who perceive that a need for more generalist physicians is stimulati ng interest in retraining specialists and subspecialists to provide pr imary medical care, physician interest and program availability remain low, and programs under development are not being designed to attract those who may seek retraining, This situation is probably fortuitous, because changed perceptions about the adequacy of the generalist phys ician workforce since the beginning of this study have diminished the call for retraining.