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Show PHYSICIAN SOCIALIZATION by Susan Root, MD, MPH Abstract Medical training is a long process involving many attitudinal and behavioral changes, often brought about by the system imposed on trainees. These changes result in physicians with dramatically different ideas and focuses after they complete the training from what they had prior to entry into medical school. These differences affect both the physician's personal life and self-esteem, and have a major impact on the choices he or she makes for practice. In particular, the choice between primary and specialty care is impacted by the forces encountered during training. If public policy is truly attempting to change the mix of physicians to favor primary care, then alterations in the medical training process will be necessary to encourage these changes. Introduction What does it mean to be a physician in modern-day American society? The general public has varying concepts of physicians, ranging from Marcus Welby and Dr. Kildare to money-hungry Medicare frauds. Physicians and prospective physicians have their own stereotypes and beliefs, and these concepts help shape their practice and their plans for the future. The training of physicians is long and arduous, imposing constraints and inculcating beliefs on those who pass through the process. This paper will examine that process and its effect on the type of physicians produced. My specific focus is on the choice between primary and specialty care. Methods To examine the current medical training process and its effect on students, residents, and practitioners, I reviewed the last five year's literature and conducted informal interviews of people participating in the process. During the same period, I was myself undergoing residency training, and my observations and experiences are also included. The interviews were conducted with everyone I encountered during two years of residency with whom I could spend sufficient time. It is not a randomized or carefully selected sample, nor is it designed to be representative of any group. Since my residency training is in pediatrics and preventive medicine, those groups are most heavily involved. My interview technique was not formal or standardized, but simply consisted of open-ended questions about why they chose medicine as a career, why they made the choices they did during the process (with particular emphasis on the issue of primary care versus specialty medicine), and what forces they felt had pushed them in one direction or another. In all, I discussed these topics with 192 people, including 14 high school students, 45 college students, 42 medical students, 54 residents, and 37 attending physicians. I have incorporated their responses throughout this paper. Since the process was neither standardized nor scientific, I have not presented statistical data about their responses. I have tried to present the major themes that emerged from the interviews, and have included some quotations representative of those themes. I refer to the trainee/practitioner as "he" throughout for simplicity, but it should be noted that 67% (129) of my sample was women. The Process of Medical Training The process of becoming a physician begins long before medical school. The desire to be a doctor must come first, and the reasons for having that desire generally include a combination of altruism and a wish to help humanity, as well as a longing for the power and respect which the status of physician has long held. This desire is usually well formed by the end of high school. The prospective entrant must then endure the hurdles of pre-medical requirements in the undergraduate years, which generally include introductory Utah's Health: An Annual Review 1993 91 |