Enthusiasm for primary care: comparing family medicine and general internal medicine

Abstract

Objective: To compare attitudes and perceptions of primary care among faculty, students, and residents oriented toward family medicine (FM) and general internal medicine (GIM).

Design: Descriptive study using confidential telephone interviews.

Participants: National stratified probability sample of FM and GIM faculty (n = 68), residents (n = 196), and students (n = 81).

Measurements and main results: We created indicators for attitudes toward primary care among the faculty that included perceptions of medical practice, experiences within the academic environment, and support for primary-care-oriented change. For the students and residents, we explored their perceptions of faculty and resident attitudes toward primary care, their perception of encouragement to enter primary care, and their satisfaction with training. Family medicine faculty showed more enthusiasm for primary care as manifested by their greater likelihood to endorse a primary care physician to manage a serious illness (FM 81.3% vs GIM 41.1%; p < .01), their strong encouragement of students to enter primary care (FM 86.2% vs GIM 36.3%; p < .01), and their greater support for primary-care-oriented changes in medical education (FM 56.8% vs GIM 14.7%; p < .01). Family medicine students and residents were more likely to perceive the primary care faculty as very satisfied with their work (FM 69.2% vs GIM 51.5%; p < .05), to feel strongly encouraged by peers toward primary care (FM 59.5% vs GIM 16.1%; p < .0001), and to have a primary care role model (FM 84.3% vs GIM 61.3%; p < .05).

Conclusions: Family medicine faculty, students, and residents showed a consistent pattern of greater enthusiasm for primary care than their GIM counterparts. This may be a reflection of the different cultures of the two disciplines.