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Show residency systems that allow completion of the requirements in fewer years than the traditional path. For example, the Gannon-Hahnemann program, a combined B.S./M.D. family medicine program in Pennsylvania, requires family practice experience during the pre-medical and medical school years. This program has been more successful at producing family practice physicians for the area than the Hahnemann University School of Medicine, despite major overlaps in curricula. The primary difference between the six-year program and the traditional system is the increased exposure to real-life primary care settings. These programs have shown positive results in creating higher than usual percentages of rural practitioners. Some conventional medical schools have undertaken similar efforts, though on a smaller scale. Texas A&M College of Medicine, in rural East Texas, was explicitly created with the goal of producing more rural family practitioners. Students begin spending time with rural providers during the second year of school (both primary and specialty providers, but with more time spent with family practitioners than any other specialty), and are required to do a one-month clerkship with a rural primary care provider during the fourth year. Students are encouraged to stay in the home of the provider during their rotation to see first-hand the lifestyle of a rural primary care provider. The school produces more rural family practitioners than any other Texas medical school, despite having one-fourth to one-half the number of students of the other six schools. This year's 1992 residency Match raised hopes that the slide in selection of primary care had reversed. The Match showed about a 5% increase in the number of students selecting family practice, general internal medicine, or pediatrics. This is the first increase in five years. The increase is, however, made up almost entirely of foreign medical graduates. U.S. graduates continue to have declining interest in primary care fields. Among American graduates, internal medicine had a 0.6% decline, pediatrics a 0.5% increase, and family medicine a 1.7% increase (Page, 1992b). The increasing percentage of foreign medical graduates in primary care programs may accelerate the drop in U.S. graduates' interest, since programs with foreign medical graduates are often perceived as inferior to those with only U.S. graduates. One ray of hope is the capitalist imperative. A recent survey of hospitals (Koska, 1988) found that most were actively recruiting family physicians, as these doctors generate large sums of money for the hospital, considering both direct admissions and referrals. Perhaps the lure of higher profits by hospitals will lead to better financial rewards and status for the primary care physician and help lead to a resurgence in the field. About the Author Susan Root, MD, MPH, grew up in Texas, where her interest in medicine was sparked by her work as a candystriper and by reading books such as Intern and Arrowsmith. Susan's undergraduate education was at Rice University and Stanford University, in anthropology and medical microbiology. After graduation, Susan worked for several years, first as a research chemist developing enzyme immunoassays for antiepileptic medications, then as a programmer/analyst and database designer. Despite Susan's reservations about the medical education process, she decided to pursue medicine as a career, and attended the Texas A&M University College of Medicine. During medical school she studied ethics in medicine, and did research on the ethical development of medical and veterinary students. Susan completed a residency in pediatrics at the University of Utah, where she just finished a second residency in preventive medicine. At this time, Susan is doing a fellowship in genetics at the University of Utah. She is planning further research in the area of genetic epidemiology and infant mortality. 100 PHYSICIAN SOCIALIZATION |