Choosing a specialty during a generalist initiative: a focus group study.
BACKGROUND
Virginia Commonwealth University (VCU) (as part of a three-school consortium) was 1 of 12 sites awarded a Robert Wood Johnson Generalist Physician Initiative (RWJ-GPI) grant. Given the goals of this initiative--to promote a balanced output of generalists and specialists--program planners wanted to understand how medical students made career decisions in the context of this curriculum change and the larger social environment.


METHODS
Seven focus groups (average size: six members each) of second-year and fourth-year students were recruited. Groups were homogeneous with respect to subspecialty or primary care orientation and career trajectory. An experienced moderator conducted all groups. The discussions were taped and transcribed. Analysis proceeded concurrently with data gathering, using a template style and with assistance from the NUD*IST software program.


RESULTS
Students from all groups hoped for control of their practice, intellectual challenge, rewarding relationships with their patients and their own families, and fair compensation for effort. They worried about their future prospects, and specialty-oriented students felt that the emphasis on primary care production was being forced on the school. All groups saw managed care as doing more harm than good for patients, and all wished for improved career counseling.


CONCLUSIONS
The RWJ-GPI at VCU became a lightning rod for student worry and resentment at being forced into primary care specialties. The backlash phenomenon was seen at other US medical schools and is one of the postulated reasons for a decline in US student numbers matching in family practice, internal medicine, and internal medicine-pediatrics. Medical school faculty should respond with constructive, pro-student policies and programs.
Kuzel
A J
AJ
Department of Family Practice, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, USA. akuzel@hsc.vcu.edu
Moore
S S
SS
D000328:Adult; D002321:Career Choice; D005194:Family Practice / Q000193:education*; D017144:Focus Groups; D006801:Humans; D013038:Specialization; D014768:Virginia