An analysis of the movement to private psychiatric practice

Survey data were analyzed from 900 psychiatrists who graduated between 1961 and 1976 from one of 17 state mental hospitals (SMHs) or ten university psychiatry residency programs in one of five states and are used to describe the differential influence of (1) foreign or US medical education, (2) SMH or university training program, and (3) years since graduation on the decision to take a job in either a private, public, or university medical school practice setting. Descriptive statistical models show that (1) about 25% of all respondents chose a private, 55% a public, and 20% a university for their first job, and (2) substantial numbers of both foreign and US medical graduates (FMGs, USMGs) left public jobs and chose and remained in private jobs, so that 55% of respondents had their current job in the private sector. Type of residency training was associated only with first job choice. Compared with USMGs, more FMGs initially took and remained in public jobs. These models highlight manpower problems. In fact, most of the respondents did not confine their work to a single kind of practice setting.