The Generalist Physician Initiative (October 1991 to June 2001) challenged schools of medicine to increase the supply of generalist physicians — specifically general internists, general pediatricians and family practitioners — that they were training.

The program was designed to address a steady decline during the 1980s of medical school graduates entering generalist practice (the percentage fell from 32 percent in 1980 to 14.5 percent in 1992). Thirteen schools of medicine participated in the full program.

The University of Missouri-Columbia (UMC) School of Medicine served as the national program office. Jack Colwill, M.D., professor and chair of the UMC Department of Family and Community Medicine during the program (and then emeritus professor) served as program director.

Key Results

• The Generalist Physician Initiative helped the medical schools create a variety of external partnerships that added value to their programs, including partnerships with HMOs and state Area Health Education Centers (AHECs).
• The Generalist Physician Initiative helped catalyze educational reform in medical schools that had had little educational change in two to three decades. Those changes included:
  • Elevating generalist faculty into major leadership roles.
  • Instituting new administrative structures to coordinate generalist activities.
  • Increasing the number of generalist faculty.
  Among the changes the schools carried out to promote generalism were:
  • Changing the admissions process to target more students with generalist potential, along with increasing the number of generalists on admissions committees.
  • Developing high school and college undergraduate recruitment programs.
  • Redesigning undergraduate medical education to include the primary-care community experiences, generalist-oriented clinical medicine courses and generalist clerkships.

Key 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 had 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 — from a baseline of 26.4 percent of graduates in 1988–1991 to 36.7 percent of graduates in 1999. By 2000, there had been a decline in generalist graduates to 32.8 percent of all graduates, so the final increase was 24 percent.
• 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, M.D., "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."

Participating Schools
The Generalist Physician Initiative included a one-and-a-half year developmental stage and two three-year implementation stages. The following 13 schools of medicine completed the entire project (see Grant Results reports linked to the school names):

• Boston University School of Medicine, Boston.
• Case Western Reserve University School of Medicine, Cleveland.
• Dartmouth Medical School, Hanover, N.H.
• East Carolina University School of Medicine, Greenville, N.C.
• Georgia Medical College, Augusta, Ga.
• Allegheny University of the Health Sciences (which became MCP Hahnemann), Philadelphia.
• University of Massachusetts Medical Center, Worcester, Mass.
• University of New Mexico School of Medicine, Albuquerque, N.M.
• New York Medical College, Valhalla, N.Y.
• Pennsylvania State University College of Medicine, Hershey, Pa.
• State University of New York at Buffalo Medical School, Buffalo, N.Y.
• University of Texas Medical Branch-Galveston, Galveston, Texas.
• The three Virginia medical schools that applied as a consortium — University of Virginia School of Medicine, Charlottesville, Va. Virginia Commonwealth University Medical College, Richmond, Va. and Eastern Virginia School of Medicine, Norfolk, Va.

Funding
The Robert Wood Johnson Foundation (RWJF) Board of Trustees authorized the program for up to $32.7 million.