Generalist Physician Initiative

An RWJF National Program

Dates of Program: October 1991 to June 2001

Field of Work: Increasing the numbers of generalist physicians practicing in the United States

Problem Synopsis: There was a steady decline during the 1980s of medical school graduates entering generalist practice (the percentage fell from 32% in 1980 to 14.5% in 1992).

Synopsis of the Work: The Generalist Physician Initiative challenged schools of medicine to increase the supply of generalist physicians—specifically general internists, general pediatricians and family practitioners—that they were training. Thirteen schools of medicine participated in the full program.

Assessment Findings

  • As part of the evaluation of the Generalist Physician Initiative, the national program office compared the 15 Generalist Physician Initiative schools with 45 schools that had applied to, but had not been accepted into, the Generalist Physician Initiative. The assessment showed that:

    • The Generalist Physician Initiative schools succeeded in elevating generalist faculty into leadership roles in the medical schools, in reorienting their undergraduate medical school curricula toward primary care education, in activating networks of community-based educators and in improving the overall quality of medical school education.
    • The schools had less success in influencing the design of residency programs, due in part to their patient-service demands and the school's lack of immediate direction of the residency programs.
    • The Generalist Physician Initiative—as measured by the Association of American Medical College's Graduation Questionnaire—increased their output of generalists by approximately 39 percent during the course of the program.
    • However, the data failed to demonstrate any difference between Generalist Physician Initiative schools and the schools that applied for but did not get program funding.

The national program office director and deputy directors speculate that the marketplace demand for generalists during the 1990s influenced all medical schools and may have blunted the particular effects of the Generalist Physician Initiative.

According to Gerald T. Perkoff, MD, "Market forces have more to do with career choice than do the needs of the system, and certainly more than philosophies."

The original RWJF Program Officer Michael Beachler concurred: "Health care system forces, unleashed in the early 90s, were more powerful than any grant program."

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