Specialty Intentions of 1995 U.S. Medical School Graduates and Patterns of Generalist Career Choice and Decision Making

Abstract

The authors report on the specialty intentions that graduating students declared on the 1995 AAMC Medical School Graduation Questionnaire (GQ) and compare the pattern of career choices in 1995 with that in 1992. Family practice was the leading choice of graduates in 1995, followed by internal medicine subspecialties and general internal medicine. These choices represented significant gains over those made in these specialties in 1992 and were at the expense of declines in the interest of 1995 graduates for internal medicine specialties, radiology, anesthesiology, obstetrics–gynecology subspecialties, and some other fields. In 1992, 14.6% of graduating students declared plans to pursue careers in one of the generalist specialties; in 1995, 27.6% declared such plans. In 1992, no school graduated 50% or more students with generalist intentions, and only one school reached 40%; in 1995, five schools graduated more than 50%, and another 15 graduated more than 40% who favored generalist careers. Medical schools with significant GQ response rates (110 out of 125) were aggregated by level of generalist production (top 25%, middle 50%, and bottom 25%) according to the percentages of their 1995 graduates selecting careers in the individual generalist specialties of family practice, general internal medicine, and general pediatrics, and in these generalist specialties in toto. Within these groups, the linking of GQ responses to declarations given by the same students on the Matriculating Student Questionnaire (MSQ) made it possible to determine the extent to which graduates' specialty choices represented early interests that were retained or interests acquired later during medical school. For the 1995 graduates who entered medical school with the intention to pursue family practice careers, up to half retained that interest, and twice that number acquired an interest in family practice later. For general internal medicine and general pediatrics, the interests of the 1995 matriculants largely were lost, and the ultimate selection of these fields by graduating students was based on interests arising later in medical school. Although these data are from only one class, they suggest that the selection of students on the basis of interest in the generalist specialties evinced when they apply to medical school is likely to hold promise only when family practice is the intended career choice. For career decisions favoring the generalist specialties, the dominant influences appear to arise during medical education and are graded across schools. Sharper definition of educational practices and socialization will permit schools to move from one level of generalist production to a higher one if they choose.

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