Retraining physicians for primary care. A study of physician perspectives and program development
I. Jacoby, N. E. Gary, G. S. Meyer, P. McCardle, J. Aurand, J. Chamberlin and A. L. Potter
Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Md 20814-4799, USA. ijacoby@usuhs.mil
OBJECTIVE: To determine the number and kinds of programs that medical
schools and managed care organizations offer or plan to offer to retrain
physician specialists to practice primary care medicine and to discover
physicians' attitudes toward such retraining. DESIGN: A survey was mailed
in 1994 to all 126 medical schools and the 19 largest US managed care
organizations to collect detailed information about existing and potential
retraining programs. Physicians' attitudes toward retraining were elicited
from participants in 3 geographically diverse focus groups. Selected
specialists were polled through the national survey of the American Medical
Association's Socioeconomic Monitoring System to ascertain the demand for
retraining. RESULTS: The majority of institutions contacted perceived a
need for retraining, but few programs had been established. Programs being
"considered" varied widely in duration, class size, target audience,
accreditation, and projected training settings. Although unenthusiastic
about retraining, physicians preferred programs that would expand their
patient base, maintain the practice population, be inexpensive and close to
home, and provide hands-on training in the eventual practice environment.
Physicians also preferred a goal-oriented, part-time retraining program in
a large group practice or managed care setting that would allow them to
practice their specialty while retraining. Few planned or existing programs
incorporate many of these features. The most likely candidates for
retraining are subspecialty physicians who currently provide some primary
care and are employed by a medical plan. CONCLUSIONS: Despite efforts by
those who perceive that a need for more generalist physicians is
stimulating interest in retraining specialists and subspecialists to
provide primary medical care, physician interest and program availability
remain low, and programs under development are not being designed to
attract those who may seek retraining. This situation is probably
fortuitous, because changed perceptions about the adequacy of the
generalist physician workforce since the beginning of this study have
diminished the call for retraining.
