What Influences Career Choices Among Graduates of a Primary Care Training Program?

OBJECTIVE: To identify factors that influence primary care residents to become generalists or specialists. DESIGN: Structured survey and interview. 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 themselves 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 clinical problems in practice ( p = .001), and opportunity for continuity of care ( p = .01). Although salary was rated “not important,” 50% of generalists and specialists advocated increased salaries for generalists as a way to increase interest in primary care. Other promoting factors included mentors, increased prestige for generalists, community‐based 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 residents pursue specialty careers. To produce more generalists, graduates recommend addressing income inequities, providing generalist role models, increasing community‐based teaching, and increasing prestige for generalists.