 December 2002 • Volume 8 • Number 12 |
When it comes time for medical students to declare their specialty choices, there may be some truth to the old adage, "It's not what you know, but whom you know."
True, there are those who are attracted from the get-go to the tremendous breadth of family practice. For them, it seems, the challenge of mastering a far-flung range of care services and skill sets is an opportunity they will relish.
But for those less certain of their ultimate career path, positive interactions with family practice mentors, especially in a clinical setting, can turn the tide in favor of the specialty.
That's just one of the findings from an Academy-sponsored study examining the factors influencing specialty choice decisions. The research was commissioned in 2000 in response to an overall drop in family practice residency match numbers and a decline in the percentage of U.S. medical school graduates choosing family practice.
The study, conducted by the University of Arizona, Tucson, consisted of three elements:
a comprehensive literature review dating back to 1993, the first of four consecutive years in which record-breaking numbers of family practice residency positions were filled;
comparisons of the 12 medical schools showing the greatest decrease in students choosing family practice with the 12 schools showing the greatest increase, including surveys of the department chairs and faculty; and
surveys of nearly 3,000 graduates of family practice, internal medicine and pediatric residencies, as well as matched samples of nonprimary care residency graduates.
The first discussion of results appeared in the August Academic Medicine. The article, "Lessons Not Learned From the Generalist Initiatives," noted that of the three traditionally recognized primary care specialties -- general internal medicine, general pediatrics and family practice -- analyses of factors thought to predict specialty choice have consistently proved to be more accurate for family practice than for the other two specialties.
Translation? Variables likely to lead students to choose family practice, such as a rural background or lower socioeconomic status, can be identified with a significant degree of accuracy in applicants to medical schools.
Moreover, the Arizona research spoke volumes about aspects of the medical school experience itself that influence specialty choice. Two characteristics, in particular, leapt out: A student's stated career goal before medical school admission did not predict selection of family practice, although stated choice after admission did; and students recruited to family practice after admission comprised the largest group entering the specialty.
According to FP Nancy Dickey, M.D., president of Texas A&M University, Bryan, it's something "we" do to "them."
"I think we have some very hard work to do, and we need to do it on a very short timeline," says Dickey. "What is it that we do when we take on these idealistic youngsters? I see it in the first six months to a year, year and a half of medical school. These students espouse and act on all of the things we want them to be and do. They are generous; they are compassionate; they are committed; they are hard-working ... but somehow between admission and the end of their third year, they have become much like some of the mature members of their profession -- cynical, jaded and somewhat less compassionate."
It's not just physicians within the academic system who have the potential to impact students' maturation and decision-making, says another FP educator. Positive role-modeling is up to each member of the specialty, says Richard Homan, M.D., dean of the Texas Tech University School of Medicine and the Graduate School of Biomedical Sciences, Lubbock.
"We play a pivotal role," says Homan. "Patients trust us. We need to promote that more. I think the family physicians who are out there are the best possible advertisement for the specialty."
Go to the AAFP Web page at http://www.aafp.org/fpr/20021200/student.html to review steps that family medicine organizations are likely to take in response to the survey results.
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.