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Choosing a career in primary care: the road not taken.

CONTEXT
Despite a mission statement and curriculum that are unique in our country in proposing to direct physicians to primary care (PC), the proportion of doctors graduating from Ben Gurion University (BGU) who choose PC is similar to that of other Israeli medical schools. OBJECTIVES, METHODS AND STUDY POPULATION: To investigate factors underlying our graduates' career choices we sent a questionnaire to six consecutive classes that had graduated from this medical school. We hypothesized that medical school was not the decisive factor influencing career choice.


RESULTS
Returns were received from 135 graduates (54%). The nature of a specialty was the most important factor in choosing a career and in rejecting PC. Differences between primary care physicians (PCPs) and non-primary care physicians (NPCPs) were identified. PCPs emphasized factors relating to their personal lives. NPCPs emphasized the nature of a specialty in career choice. The most important factor in choosing PC was the physician-patient relationship and human aspects of medicine. Medical school was viewed as playing a minor role in career choice. PROPOSED INTERVENTIONS: Graduates proposed methods to increase the proportion of doctors choosing PC. These included: economic incentives; changing work conditions; strengthening contact with tertiary care; continuing medical education; and changing PC clerkships in medical school.


CONCLUSION
The inherent nature of a specialty is central to career choice. In PC, the patient-physician relationship is central to physicians' career choice.