Developing generalists for Kentucky.
Since 1985, nearly half of the graduates of the University of Kentucky College of Medicine have chosen generalist careers, even though its students received almost no outpatient ambulatory training in primary care before 1990. This study determined the factors influencing the choice of generalist specialties in the absence of ambulatory training experience. A questionnaire was mailed to the 516 graduates of the classes of 1964 through 1989 who had entered a generalist specialty. A three-way ANOVA with one repeated measure was used to determine whether there were statistically significant differences in the responses of practitioners in the three generalist specialties (family practice, general internal medicine, or general pediatrics). Sufficiently complete responses were received from 187 graduates (116 family practitioners, 40 general pediatricians, and 31 general internists). Many of the physicians who had spent formative years in rural areas were practicing in rural communities. Many respondents had already decided upon a generalist career before entering medical school. Clerkships in internal medicine and pediatrics were an important influence, as was mentor role modeling. For pediatricians, an elective ambulatory care experience was also important. Educational experiences exert meaningful influences on students interested in a generalist career. Formal ambulatory care training experiences, while not critical for the selection of a generalist career, may heighten or confirm interest. Efforts that encourage students from rural communities to enter medical school appear to produce rural physicians.