The timing of career decisions in internal medicine.

The creation of new residencies in primary care internal medicine is aimed at increasing the number of individuals entering careers as general internists. This strategy assumes that final career decisions are made prior to application for residency training. A survey of all graduates of internal medicine residencies at the University of California, San Diego, during 1969-1979 resulted in 155 respondents (an 86 percent response rate) and revealed that only 30 percent had no change in career plans regarding general versus subspecialty practice since medical school and 41 percent had made final decisions during residency training. Inpatient care experiences, peer interactions, and faculty role models were the training factors which most influenced final career choice. The goal of increasing the number of general internists may be better served by strengthening the role of generalist faculty members in traditional internal medicine residencies rather than creating new programs which force trainees to make premature career choices.