Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

Abstract

PURPOSE: Professional and governmental organizations recommend an ideal US physician workforce composed of at least 40 % primary care physicians. They also support primary care residencies to promote careers in primary care. Our study examines the relationship between graduation from a primary care or categorical internal medicine residency program and subsequent career choice. METHODS: We conducted a cross-sectional electronic survey of a cohort of internal medicine residency alumni who graduated between 2001 and 2010 from a large academic center. Our primary predictor was graduation from a primary care versus a categorical internal medicine program and our primary outcome is current career role. We performed chi-square analysis comparing responses of primary care and categorical residents. RESULTS: We contacted 481 out of 513 alumni, of whom 322 responded (67 %). We compared 106 responses from primary care alumni to 169 responses from categorical alumni. Fifty-four percent of primary care alumni agreed that the majority of their current clinical work is in outpatient primary care vs. 20 % of categorical alumni (p<0.001). While 92.5 % of primary-care alumni were interested in a primary care career prior to residency, only 63 % remained interested after residency. Thirty of the 34 primary care alumni (88 %) who lost interest in a primary care career during residency agreed that their ambulatory experience during residency influenced their subsequent career choice. CONCLUSIONS: A higher percentage of primary care alumni practice outpatient primary care as compared to categorical alumni. Some alumni lost interest in primary care during residency. The outpatient clinic experience may impact interest in primary care.

Hostility During Training: Historical Roots of Primary Care Disparagement

“…Several recent studies have identified the importance of culture, [42][43][44][45] providing more evidence that medical training can contribute to trainees' disinterest in primary care. 43,46,47 Additionally, the structure of medical education continues to emphasize specialty medicine while the content and rewards of primary care are all to frequently overlooked. 20 Some respondents offered examples of positive support for navigating the hostile structure and culture of medical school, pointing to possible responses to the problem.…”

Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study

“…7,8 Recent evidence has found that the quality of continuity clinic experience is related to internal medicine resident satisfaction, 9 and that training models with blocks of protected outpatient time that are separate from inpatient responsibilities may also increase resident satisfaction with their primary care rotations. 10 In addition, the outpatient clinic experiences of residents may be associated with retained interest in primary care careers, 11 though the influence of various factors may also differ by year of training and may be influenced by other experiences prior to residency. 12,13 However, these studies have focused on specific factors, such as residency training satisfaction, and there is a need to understand holistically how the diverse experiences of trainees impact the decision to pursue primary care or another Electronic supplementary material The online version of this article (doi:10.1007/s11606-016-3825-9) contains supplementary material, which is available to authorized users.…”

Pilot phase evaluation of the elective general practice class: results of student surveys of the first two years

“…Currently ongoing international studies show that, in spite of positive educational benefits, even elaborately designed and realised curricular interventions have less influence upon the choice of medical specialty and the location of a practice than personal “practical experiences” [16], [17]. Accordingly, mentors are an indispensable part of similar projects [7], [8] and are particularly recommended for sitting in on lectures in the early phases of study, for which both students and mentors must however be prepared [6], [18], [19].…”