Rejecting family practice: Why medical students switch to other specialties

Background and Objectives: Medical schools have been encouraged to increase the number of primary care graduates. This study, determined the proportio n of medical students who change specialty preference during the clinical y ears and explored how ultimate choice is affected by perceptions of medical specialties acquired during this period. Methods: A survey was mailed to 3 97 graduating medical students at the University of California, San Francis co (UCSF) after the National Resident Matching Program Match and before gra duation in 1996, 1997, and 1998. Results: The response rate rc ns 81% (320/ 397). Of 41 respondents who reported that family practice had been their f irst specialty choice prior to beginning clinical rotations, only 15 (37%) eventually matched in family practice. Comparable numbers for internal medi cine and pediatrics rt ere 50% and 69%. Students rejected family practice w ere more likely than their colleagues rejecting other specialties to cite i nsufficient prestige, low intellectual content, and concern about mastering too broad a content area as reasons. Conclusions: At UCSF, family practice retains fewer interested students than other primary care specialties. To reverse this trend schools such as UCSF need to mise the prestige of family practice and counter concerns about its intellectual content being impossi ble to master.