The educational and training system has not influenced interest in generalist careers. Without substantive change in mentorship or curriculum, generalism saw an upsurge in interest among U.S. graduates during the 1990s when most were told, implicitly or explicitly, that managed care would create a future health care delivery system oriented toward primary care. Conversely, anesthesia, among predictions of future surplus, experienced a precipitous drop in applications to residency programs. Multivariate analysis of medical school graduates in 1995 suggested that demographic factors were more important to choosing a career in generalism than were generalist missions, curricula, or admissions preferences for students with a stated interest in generalist careers (14). The surge in interest in primary care was short-lived, and young physicians quickly altered their career paths, again with no antecedent, sweeping changes in education and training.