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Academia and the Profession |

Career Differences between Primary Care and Traditional Trainees in Internal Medicine and Pediatrics

John Noble, MD; Robert H. Friedman, MD; Barbara Starfield, MD; Arlene Ash, PhD; and Charlyn Black, MD, ScD
[+] Article and Author Information

Grant Support: In part by Contract No. HRSA 240-85-0048, Division of Medicine, Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services. Fellowship support was provided to Dr. Black by the National Health Research and Development Program of Canada.

Requests for Reprints: John Noble, MD, Section of General Internal Medicine, Boston City Hospital, 818 Harrison Avenue, Boston, MA 02118.

Current Author Addresses: Dr. Noble: Section of General Internal Medicine, Boston City Hospital, 818 Harrison Avenue, Boston, MA 02118. Drs. Friedman and Ash: Doctor's Office Building, Evans Medical Group, 720 Harrison Avenue, Boston, MA 02118. Dr. Starfield: Department of Health Policy and Management, Johns Hopkins University, Hampton House, 624 North Broadway, Baltimore, MD 21205-1901.

Dr. Black: Community Health Sciences, S101-750 Bannalyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada.


© 1992 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1992;116(6):482-487. doi:10.7326/0003-4819-116-6-482
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Objective: To assess the relation of Primary Care Residency Training to career choice, board certification, and practice location of internists and pediatricians.

Design: Cohort study with up to 8 years of follow-up.

Setting: The United States.

Participants: The 17 933 residents trained in all internal medicine (13 750) and pediatrics (4183) residency programs between 1977 and 1982 were studied using information from the National Resident Matching Program, the AMA Physician Masterfile, the Area Resource File, and a telephone survey.

Measurements: Career choice, board certification, and practice location were studied in relation to five explanatory variables: type of residency (primary care or traditional track), gender, year of medical school graduation, educational orientation of the teaching hospital, and medical school prestige.

Main Results: Graduates of primary care residency training programs chose careers in generalist primary care significantly more often than did graduates of traditional tracks in both internal medicine (72% compared with 54%) and pediatrics (88% and 81%, respectively; P < 0.001 for both values). Board certification rates in internal medicine were statistically higher for graduates of primary care training programs (80%) than for graduates of traditional programs (76%, P = 0.002) but were not statistically significant for both groups of pediatric graduates. Graduates of primary care programs in pediatrics and internal medicine practiced in medically less served communities more often than did graduates of traditional programs.

Conclusion: Graduates of primary care residency training programs in internal medicine and pediatrics differ from graduates of traditional residency programs in career choices, board certification rates, and practice locations.

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