A SYSTEMATIC ANALYSIS OF HOW MEDICAL-SCHOOL CHARACTERISTICS RELATE TOGRADUATES CHOICES OF PRIMARY-CARE SPECIALTIES

Purpose. To examine medical school characteristics, in particular fede ral funding for biomedical research, as they relate to the graduates' choices of family medicine, general internal medicine, general pediatr ics, or all three specialties. Method. Data were collected for 121 U.S . medical schools, including information on funding, faculty, curricul a, and other school characteristics. In addition, a questionnaire was mailed to the schools requesting information about non-federal funding for primary care, primary care department characteristics, and primar y care representation on the admission, curriculum, and promotion and tenure committees. Analyses were carried out separately for each speci alty and for all three combined. The first multiple regression analysi s was done to predict specialty choice (proximate predictors), the sec ond to predict the predictors of specialty choice (intermediate predic tors), and the third to predict those predictors (distal predictors). Results. Prediction was best for family medicine practice. Interest at matriculation and required third-year and fourth-year time in primary care were the two best proximate predictors. The best predictors of i nitial interest were the percentage of rural students and special prog rams for primary care, while the best predictors of required time in p rimary care were funding for family medicine and the percentage of fac ulty in family medicine (intermediate predictors). The best predictor of the percentage of faculty in family medicine was funding for family medicine (distal predictor). Conclusion. The results suggest that the most effective way to increase the number of physicians with generali st practices is to increase the number of students interested in a fam ily medicine career at matriculation.