Research from Kansas City-based University of Kansas suggests cultural and structural attitudes to primary care in medical training may contribute to the nation's shortage of primary care physicians.
Published in the Annals of Family Medicine, the study is based on 52 oral histories from the National Library of Medicine. Using qualitative analysis and constant comparative methods, the study found 63.5 percent of the histories studied indicated discouragement or disparagement of primary care at some point during their medical training.
Discouragement against primary care was notably more common among male respondents, according to the report, but worsened for females after 1977. Some respondents reported support for general practice, but it was not common.
One respondent, an internal medicine physician from the University of Minnesota Medical School in Minneapolis, said, "When I first started as a generalist that was not the thing to do…the attitude was that if you were in general medicine, then you were too dumb to get a fellowship." The physician added, "I remember one of my former professors came over to give grand rounds…. I hadn't seen him for a couple of years, and he said, 'Gosh, hey…what are you doing?' And I said, 'Well, you know, I'm in general medicine…' and you would have thought I said I'd been in jail for 2 years."
The analysis suggests disparagement begins as early as the application process and continued throughout training.
"The primary care shortage, as well as primary care's unfavorable representation during training, is a multifaceted problem. As evidenced here, cultural and structural problems are critical components of the problem," the author wrote.
Read more here.
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