Medical doctor specialization:a system approach.

The patient who consults a doctor initiates a system of interaction. Through time certain facets of the interaction can be expected to stabilize. Certain of these qualities which will characterize the stabilized system can be considered depended upon objective and/or universal facts. This thesis has considered the doctor-patient dyad as a problem solving system. The malady which the patient introduces into the system is the "problem" which the doctor must solve. Hence, two types of activity may be seen to occur within the system: Instrumental behavior which is directly task oriented, and social-emotional behavior conducted in order to manage the emotional concomitants of the instrumental behavior. It is suggested, therefore, that specialties will vary as to the proportion of system resources which must be allocated to this later function. It was hypothesized that this area of behavior would constitute a sufficiently significant role characteristic to be influential in medical doctor specialty-choice decision. In order to assess the importance of interpersonal expectations in determining specialty-choice decisions, questionnaires were mailed to the graduating classes of 1958 and 1959 of the College of Medicine of the University of Utah. The question which this thesis reported asked the doctors to indicate which of several factors had influenced them the most in selecting their specialty. One of the items stated: "Your specialty has less direct patient contact." The specialties represented in the sample were ranked by a panel of 10 medical doctors according to the amount of patient contact each of the specialties requires. The specialties were then dichotomized into high and low interaction categories. The doctors were therefore divided into three categories: general practitioners, higher interaction specialists, and low interaction specialists. Two hypotheses were tested: 1.High interaction specialists will indicate less patient contact less often than will low interaction specialists. 2. General practitioners will respond in a manner more similar to high interaction specialist than to low interaction specialists. The data, analyzed by X[2], evidence differences in the predicted direction (P<.01). Further analysis and discussion of the data suggest that future research in this area should make use of the high-low dimension employed in this research as it appears more powerful than then more conventional general practice-specialty dichotomy. The question of the validity of these competing taxonomies can only be answered following a comparison of their respective utilities in future research. An example of the way in which the categories of this research might prove fruitful in future efforts would be an analysis of specialty choice as a function of medical school performance. To what degree does the superior student come to highly value technical competence and deprecate social-emotional activities as a waste of time? In the past, research into this general area has been confounded by the problem of specialization artifacts. That is, residence appointments and other factors are correlated with medical school performance. Thus, it is desirable to compare specialties which differ in the social-emotional area rather than compare general practice with specialties.