Marketplace reforms and primary care career decisions

A dramatic shift in the postgraduate career choices of medical school gradu ates toward primary care occurred during the mid-1990s. While some attribut ed this shift to changes in medical school curricula, perceptions stemming from marketplace reforms were probably responsible. For the most part, thes e perceptions were probably generated through informal communications among medical students and through the media. More recently, additional marketpl ace influences, such as the consumer backlash toward managed care and unrea lized gains in primary care physicians' personal incomes, may have fostered contrasting perceptions among medical students, leading to career choices away from primary care, particularly family practice. The authors offer two recommendations for enhancing the knowledge of medical students concerning workforce supply and career opportunities: an educational seminar in the s econd or third year of medical school, and a public-private partnership bet ween the Bureau of Health Professions and the Association of American Medic al Colleges to create a national database about the shape of the primary ca re and specialty workforces, accessible through the Internet for educators, students, and policymakers. The authors conclude that appropriate career c ounseling through these efficient methods could avoid future abrupt swings in specialty choices of medical school graduates and may facilitate a more predictable physician workforce supply.