Withdrawal and Extended Leave during Residency Training: Results of a National Survey.

PURPOSE: This study was undertaken to promote communication among faculty regarding the impact of a proposed goal that 50% of the graduates of Jefferson Medical College enter generalist careers. Since the opinions and attitudes of faculty regarding career decisions may directly or indirectly influence students, the authors investigated faculty's views of the optimal ratio of primary care to non-primary care physicians in the workforce and their perceptions of the effect on medical education, research, and health care delivery if the 50% goal were to be mandated. METHOD: A questionnaire was mailed in January 1994 to all 684 salaried faculty of Jefferson Medical College. Respondents' opinions about the optimal primary care to non-primary care ratio and their perceptions of the effects of implementing the 50% goal on 21 areas related to medical education, research, and health care delivery were examined using a Likert-type scale. Obstacles perceived by non-primary care physicians as preventing their practice of primary care were also among the outcome measures. RESULTS: A total of 275 completed questionnaires were received (40% response rate; 72 primary care physicians, 141 non-primary care physicians, and 62 non-physicians). The median and mode of an optimal primary care to non-primary care ratio were both 50/50. Faculty, in general, perceived that implementing the 50% goal would enhance public access to primary care, physician-patient relationships, utilization of non-physicians, and the career satisfaction of generalists. They predicted decreases in costs of care, freedom of career choice, funding, and interest in research. The primary care physicians perceived greater enhancements of the image of physicians, quality of care, and satisfaction of generalists and subspecialists than did the non-primary care physicians. Gender and age did not affect the perceptions. A lack of appropriate training was identified by 45% and a lack of interest by 28% of the non-primary care physicians as major obstacles to their practice of primary care medicine. CONCLUSION: The faculty members' positive and negative views of the proposed reform can provide useful information to the institution in understanding the potential impediments to increasing the numbers of generalist graduates. The generalists had significantly different views from the subspecialists about the impact of increasing the proportion of primary care physicians on health care delivery and research. In general the primary care physicians were more likely to view the proposed changes as beneficial than were the non-primary care physicians.