The transition to practice.

Sixty-eight graduating resident physicians were interviewed during their final months of training to investigate the process and problems of selecting a practice after years of tightly structured medical education. The practice choice decision-making process commonly followed this sequence of steps: (a) acknowledging and undertaking the practice choice task; (b) defining personal, professional, and family issues; (c) establishing reward priorities and minimal requirements; (d) determining a professional presentation; (e) inquiring about practice opportunities in the professional market; (f) interviewing; (g) negotiating; (h) committing to a practice; (i) preparing for practice; and (j) using decision facilitators. The young physicians reported a characteristic pattern of affective reactions (for example, distressing anxiety when faced with the practice choice task; depression when forced to compromise among conflicting professional aspirations, personal needs, family expectations, and practice rewards; and a feeling of reconsolidation and growth upon commitment to a particular practice) accompanying the practice choice process.