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Developing generalists for Kentucky

A V Blue¹, M B Donnelly, P Harrell-Parr

¹University of Kentucky College of Medicine, Lexington, USA.

The Journal of the Kentucky Medical Association

|October 1, 1996

Summary

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Many University of Kentucky medical graduates chose generalist careers, influenced by early career decisions and clerkships, even without extensive primary care training. Rural background also predicted rural practice.

Area of Science:

Medical Education
Primary Care Physician Workforce
Generalist Specialties

Background:

University of Kentucky College of Medicine graduates show a high rate of generalist career choices.
This trend persisted despite limited outpatient ambulatory training in primary care before 1990.

Purpose of the Study:

To identify factors influencing generalist specialty selection among physicians.
To understand the impact of educational experiences on career choices in the absence of extensive ambulatory training.

Main Methods:

A questionnaire was distributed to 516 University of Kentucky College of Medicine graduates from 1964-1989 who entered generalist specialties.
Responses from 187 physicians (family practice, general internal medicine, general pediatrics) were analyzed using a three-way ANOVA.

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Main Results:

A significant portion of physicians from rural backgrounds practiced in rural communities.
Many respondents decided on generalist careers before medical school.
Internal medicine and pediatric clerkships, along with mentor role modeling, were influential. Elective ambulatory care was important for pediatricians.

Conclusions:

Educational experiences significantly influence medical students' interest in generalist careers.
Formal ambulatory care training may reinforce, but is not critical for, selecting a generalist path.
Programs encouraging rural students appear effective in producing rural physicians.