Medical School and Student Characteristics That Influence Choosing a Generalist Career

OBJECTIVE: To identify predictors in medical schools that can be manipulated to affect the proportion of graduates entering generalist practice. DESIGN AND PARTICIPANTS: Cross-sectional and retrospective studies of medical schools and practicing generalist physicians; surveys of MD-granting and DO-granting medical schools; site visits to nine schools with a high proportion of graduates becoming generalist physicians; surveys of national samples of MD and DO generalist physicians. INDEPENDENT VARIABLES: Characteristics of medical schools, including structural characteristics, financing, mission, admissions policies, student demographics, curriculum, faculty, and the production of generalist physicians; information on personal characteristics, background, perceptions, and attitudes of practicing generalist physicians. DEPENDENT VARIABLE: Estimated proportion of graduates of the classes of 1989, 1990, and 1991 in family practice, general internal medicine, and general pediatrics. RESULTS: Institutional mission, certain admissions policies, characteristics of entering students, and the presence of a primary care-oriented curriculum explained statistically significant variation in the number of physicians choosing generalist careers, even after the structural characteristics of public or private status, age of the school, and class size were controlled for statistically. CONCLUSIONS: Public and institutional policies, where implemented, have had a positive effect on students' choice of generalist careers. The most influential factors under the control of the medical school are the criteria used for admitting students and the design of the curriculum, with particular emphasis on faculty role models. Personal social values was the individual characteristic that most strongly influenced graduates' career choice.