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Attitudes of Internal Medicine Subspecialty Fellows Toward Primary Care

Attitudes of Internal Medicine Subspecialty Fellows Toward Primary Care Abstract • Subspecialists deliver a substantial proportion of primary care but little is known about how their training affects their attitudes toward this role. We surveyed a department of medicine to determine fellows' (N=34) attitudes toward primary care and how these compared with the attitudes of house staff (N=45) and faculty (N=66). Continuous, coordinated, and accessible care as departmental policy was almost unanimously endorsed by all physicians. In contrast, fellows less often supported the provision of such care for their own patients in actual clinical situations. Fellows were also less likely than either house staff or faculty to endorse primary care attributes for their own patients. Departments of medicine should examine how negative attitudes toward primary care develop in subspecialty fellows and whether these attitudes persist after fellowship. (Arch Intern Med 1984;144:329-333) References 1. Millis JS: The Graduate Education of Physicians . Chicago, American Medical Association, 1966. 2. Are Enough Physicians of the Right Types Trained in the United States? General Accounting Office, publication 77-92. Government Printing Office, 1978. 3. Scheffler RM, Weisfield N, Ruby G, et al: A manpower policy for primary health care. N Engl J Med 1978;298:1058-1062.Crossref 4. Federated Council for Internal Medicine: Federated Council for Internal Medicine statement on manpower. Ann Intern Med 1979;90:108-109.Crossref 5. Tarlov AR, Weil PA, Schlieter MK: National study of internal medicine manpower: III. Subspecialty fellowship training 1976-1977. Ann Intern Med 1979;91:287-294.Crossref 6. Tarlov AR, Schleiter MK, Weil PA: National study of internal medicine manpower: IV. Residency and fellowship training 1977-1978 and 1978-1979. Ann Intern Med 1979;91:295-300.Crossref 7. Steinberg EP, Lawrence RS: Where have all the doctors gone? Physician choices between specialty and primary care practice. Ann Intern Med 1980;93:619-623.Crossref 8. The Supply of Health Manpower: 1970 Profiles and Projections to 1990 . US Dept of Health, Education, and Welfare publication (HRM) 75-38. Bureau of Health Resources, 1974. 9. Girard RA, Mendenhall RC, Tarlov AR, et al: A national study of internal medicine and its subspecialties: I. An overview of the practice of internal medicine. Ann Intern Med 1979;90:965-975.Crossref 10. Mendenhall RC, Tarlov AR, Girard RA, et al: A national study of internal medicine. Ann Intern Med 1979;91:275-287.Crossref 11. Aiken LH, Lewis CE, Craig J, et al: The contribution of specialists to the delivery of primary care: A new perspective. N Engl J Med 1979;300: 1363-1370.Crossref 12. Relman AS: Who will train all those primary care physicians? N Engl J Med 1978;299:652-653.Crossref 13. Weil PA, Schleiter MK, Tarlov AR: National study of internal medicine manpower: II. A typology of residency training programs in internal medicine. Ann Intern Med 1978;89:702-715.Crossref 14. Greganti MA, Fletcher SW, Fletcher RH, et al: Primary health care: Perspective of the faculty of a department of medicine. Arch Intern Med 1982;142:325-329.Crossref 15. Institute of Medicine, Division of Health Manpower and Resources Development: A Manpower Policy for Primary Health Care: Report of a Study . Washington, DC, National Academy of Sciences, 1978. 16. Parker AW, Walsh JM, Coon AM: A normative approach to the definition of primary health care. Milbank Mem Fund Q 1976;54:415-437.Crossref 17. Starfield B: Measuring the uniqueness of primary care. J Ambulatory Care Management . 1979;2/3:91-99. 18. Kane RL: Primary care: Contradictions and questions. N Engl J Med 1977;296:1410-1411.Crossref 19. Louis MR: Surprise and sense making: What newcomers experience in entering unfamiliar organizational settings. Admin Sci Q 1980;25:226-251.Crossref 20. Weiss HM: Social learning of work values in organizations. J Appl Psychol 1978;63:711-718.Crossref 21. Kendall PL, Selvin HC; Tendencies towards specialization in medical training , in RK Merton, GG Reader, PL Kendall (eds): The Student-Physician . Cambridge, Mass, Harvard University Press, 1957, pp 153-174. 22. Becker HS, Geer B: The fate of idealism in medical school. Am Sociol Rev 1958;23:50-56.Crossref 23. Fletcher RH, O'Malley MS, Earp JA, et al: Patients' priorities for medical care. Med Care 1983;23:234-242.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Attitudes of Internal Medicine Subspecialty Fellows Toward Primary Care

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1984.00350140147021
Publisher site
See Article on Publisher Site

Abstract

Abstract • Subspecialists deliver a substantial proportion of primary care but little is known about how their training affects their attitudes toward this role. We surveyed a department of medicine to determine fellows' (N=34) attitudes toward primary care and how these compared with the attitudes of house staff (N=45) and faculty (N=66). Continuous, coordinated, and accessible care as departmental policy was almost unanimously endorsed by all physicians. In contrast, fellows less often supported the provision of such care for their own patients in actual clinical situations. Fellows were also less likely than either house staff or faculty to endorse primary care attributes for their own patients. Departments of medicine should examine how negative attitudes toward primary care develop in subspecialty fellows and whether these attitudes persist after fellowship. (Arch Intern Med 1984;144:329-333) References 1. Millis JS: The Graduate Education of Physicians . Chicago, American Medical Association, 1966. 2. Are Enough Physicians of the Right Types Trained in the United States? General Accounting Office, publication 77-92. Government Printing Office, 1978. 3. Scheffler RM, Weisfield N, Ruby G, et al: A manpower policy for primary health care. N Engl J Med 1978;298:1058-1062.Crossref 4. Federated Council for Internal Medicine: Federated Council for Internal Medicine statement on manpower. Ann Intern Med 1979;90:108-109.Crossref 5. Tarlov AR, Weil PA, Schlieter MK: National study of internal medicine manpower: III. Subspecialty fellowship training 1976-1977. Ann Intern Med 1979;91:287-294.Crossref 6. Tarlov AR, Schleiter MK, Weil PA: National study of internal medicine manpower: IV. Residency and fellowship training 1977-1978 and 1978-1979. Ann Intern Med 1979;91:295-300.Crossref 7. Steinberg EP, Lawrence RS: Where have all the doctors gone? Physician choices between specialty and primary care practice. Ann Intern Med 1980;93:619-623.Crossref 8. The Supply of Health Manpower: 1970 Profiles and Projections to 1990 . US Dept of Health, Education, and Welfare publication (HRM) 75-38. Bureau of Health Resources, 1974. 9. Girard RA, Mendenhall RC, Tarlov AR, et al: A national study of internal medicine and its subspecialties: I. An overview of the practice of internal medicine. Ann Intern Med 1979;90:965-975.Crossref 10. Mendenhall RC, Tarlov AR, Girard RA, et al: A national study of internal medicine. Ann Intern Med 1979;91:275-287.Crossref 11. Aiken LH, Lewis CE, Craig J, et al: The contribution of specialists to the delivery of primary care: A new perspective. N Engl J Med 1979;300: 1363-1370.Crossref 12. Relman AS: Who will train all those primary care physicians? N Engl J Med 1978;299:652-653.Crossref 13. Weil PA, Schleiter MK, Tarlov AR: National study of internal medicine manpower: II. A typology of residency training programs in internal medicine. Ann Intern Med 1978;89:702-715.Crossref 14. Greganti MA, Fletcher SW, Fletcher RH, et al: Primary health care: Perspective of the faculty of a department of medicine. Arch Intern Med 1982;142:325-329.Crossref 15. Institute of Medicine, Division of Health Manpower and Resources Development: A Manpower Policy for Primary Health Care: Report of a Study . Washington, DC, National Academy of Sciences, 1978. 16. Parker AW, Walsh JM, Coon AM: A normative approach to the definition of primary health care. Milbank Mem Fund Q 1976;54:415-437.Crossref 17. Starfield B: Measuring the uniqueness of primary care. J Ambulatory Care Management . 1979;2/3:91-99. 18. Kane RL: Primary care: Contradictions and questions. N Engl J Med 1977;296:1410-1411.Crossref 19. Louis MR: Surprise and sense making: What newcomers experience in entering unfamiliar organizational settings. Admin Sci Q 1980;25:226-251.Crossref 20. Weiss HM: Social learning of work values in organizations. J Appl Psychol 1978;63:711-718.Crossref 21. Kendall PL, Selvin HC; Tendencies towards specialization in medical training , in RK Merton, GG Reader, PL Kendall (eds): The Student-Physician . Cambridge, Mass, Harvard University Press, 1957, pp 153-174. 22. Becker HS, Geer B: The fate of idealism in medical school. Am Sociol Rev 1958;23:50-56.Crossref 23. Fletcher RH, O'Malley MS, Earp JA, et al: Patients' priorities for medical care. Med Care 1983;23:234-242.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1984

References